Laparoscopic Approach to Anorectal Malformations

  • Alejandra Vilanova-SánchezEmail author
  • Richard J. Wood
  • Rebecca M. Rentea
  • Marc A. Levitt


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 [1]. 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 [2]. 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) [3].


  1. 1.
    Bischoff A, Levitt MA, Peña A. Update on the management of anorectal malformations. Pediatr Surg Int. 2013;29:899–904.CrossRefGoogle Scholar
  2. 2.
    Georgeson K. Laparoscopic-assisted anorectal pull-through. Semin Pediatr Surg. 2007;16:266–9.CrossRefGoogle Scholar
  3. 3.
    Bischoff A, Martinez-Leo B, Peña A. Laparoscopic approach in the management of anorectal malformations. Pediatr Surg Int. 2015;31:431–7.CrossRefGoogle Scholar
  4. 4.
    Bischoff A, Levitt MA, Peña A. Laparoscopy and its use in the repair of anorectal malformations. J Pediatr Surg. 2011;46:1609–17.CrossRefGoogle Scholar
  5. 5.
    Alam S, Lawal TA, Peña A, Sheldon C, Levitt MA. Acquired posterior urethral diverticulum following surgery for anorectal malformations. J Pediatr Surg. 2011;46:1231–5.CrossRefGoogle Scholar
  6. 6.
    Wang C, Diao M, Li L, Liu S, Chen Z, Li X, Cheng W. Laparoscopic dissection and division of distal fistula in boys with rectourethral fistula. J Surg Res. 2017;211:147–53.CrossRefGoogle Scholar
  7. 7.
    Srimurthy KR, Ramesh S, Shankar G, Narenda BM. Technical modifications of laparoscopically assisted anorectal pull-through for anorectal malformations. J Laparoendosc Adv Surg Tech A. 2008;18:340–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alejandra Vilanova-Sánchez
    • 1
    Email author
  • Richard J. Wood
    • 2
  • Rebecca M. Rentea
    • 2
  • Marc A. Levitt
    • 2
  1. 1.Pediatric Surgery, Colorectal UnitUniversity Hospital La PazMadridSpain
  2. 2.Center for Colorectal and Pelvic ReconstructionNationwide Children’s HospitalColumbusUSA

Personalised recommendations