Postoperative complications in boys with anorectal malformations depending on the surgical approach

Abstract

BACKGROUND: The incidence of anorectal malformations is from 1:1500 to 1:5000 live births. There is currently no consensus regarding the choice of an operative method of treatment of some types of anorectal malformations occurring in boys. Anorectoplasty could be performed both through the posterior sagittal approach and using laparoscopic techniques.AIMS: to assess the risk of postoperative complications and determine their specificity in boys with anorectal malformations, depending on the surgery approach.MATERIALS AND METHODS: A single-center retrospective cohort study was performed. Male patients with anorectal malformations were included, who underwent surgical correction of anorectal malformation by performing posterior sagittal (group I) or laparoscopic-assisted anorectoplasty (group II) at the age of up to 1 year at the N.F. Filatov Children's City Clinical Hospital in the period from 2008 to 2022. Postoperative and intraoperative complications were recorded, as well as the number of necessary redo surgical interventions to correct complications.RESULTS: Group I included 33 patients, of which 18 (55%) were diagnosed with anorectal malformations with bulbar fistula, 12 (36%) - anorectal malformations without fistula, 3 3 (9%) - prostatic fistula. Group II consisted of 99 patients, of which 53 (54%) were diagnosed with anorectal malformations with prostatic fistula, 30 (30%) with anorectal malformations with bulbar fistula, 9 (9%) with anorectal malformations with bladder neck fistula, 7 (7%) - anorectal malformations without a fistula. The overall incidence of intra- and postoperative complications was statistically significantly higher in children after posterior sagittal anorectoplasty compared with laparoscopic-assisted anorectoplasty: I - 19 (58%) vs II - 33 (33%); p = 0.014. The number of redo surgical interventions for the correction of complications did not differ significantly between the studied groups: I - 8 (24%) vs II - 26 (26%); p = 0.819. A significantly greater risk of urethral injury was identified with posterior sagittal anorectoplasty compared with laparoscopic-assisted anorectoplasty: I - 4 (12%) vs II - 0 (0%); p 0.001.We did not find postoperative complications more typical for both laparoscopic-assisted and posterior sagittal anorectoplasty.CONCLUSIONS: The results define laparoscopic-assisted anorectoplasty as a viable and promising method that does not have specific postoperative complications if it is technically correctly performed. It is required to develop clear criteria for the mobilization of the rectum and the volume of rectourethral fistula dissection during laparoscopic-assisted anorectoplasty, which will minimize the risks of postoperative complications and the need for redo surgery.