Laparoscopic Approach to Anorectal Malformations
Anorectal malformations (ARM) are relatively common in children, affecting 1/5000 live births. Since the description of the posterior sagittal anorectoplasty (PSARP), the rectum is most often easily reachable from a posterior sagittal approach . However, there are some malformations in which the rectum is located high in the pelvis and can benefit from a combined abdominal and perineal approach . It is important to understand that if the fistula is low in the pelvis, below the peritoneal reflection (low rectoprostatic or rectobulbar or low rectum without a fistula), it may be more difficult to mobilize the very distal rectum away from the urinary/gynecologic tract utilizing an abdominal approach. Inadequate ligation of the fistula results in a retained remnant of the original fistula (ROOF) .