Comparative Study on the Outcome of Laparoscopic-assisted 2 Stage and 3 Stage Anorectoplasty

Background

The treatment of anorectal malformations (ARM) with laparoscopic-assisted anorectoplasty (LAARP) and concurrent colostomy closure remains contentious. This study sought to examine the mid-term outcomes of 2 stage and 3 stage LAARP.

Methods

This study encompassed 251 children who received LAARP at our center from June 2007 to December 2019; 32 children underwent 2 stage LAARP, while the remaining 219 children underwent 3 stage LAARP. A 1:4 propensity score matching (PSM) post hoc comparison was conducted between the two groups regarding complications and mid-term bowel function.

Results

Following PSM, 26 and 83 patients were incorporated into the two groups, exhibiting no significant differences in baseline data (P > 0.05). The complication rate was greater in the 2 stage group compared to the 3 stage group (P = 0.002), and the occurrence of rectal prolapse was different between the two groups (50.0 % vs. 15.7 %, P = 0.000). The overall cost of the 2 stage group was comparable to that of the 3 stage group (Ɏ69,390 vs. Ɏ67,458, P = 0.697). The total postoperative hospitalization was identical across the two groups (P = 0.633). The median follow-up ages were 7.07 years and 5.97 years, respectively, with no significant difference in BFS (P = 0.730) or distribution between the two groups (P = 0.193). No difference in modified Krickenbeck scores after 3 months of bowel management (P = 0.569).

Conclusions

The 2 stage LAARP surgery of ARMs did not yield cost savings, decrease postoperative hospitalization, or enhance prognosis, while simultaneously elevating the occurrence of postoperative rectal prolapse and familial burden.