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| Year : 2003 | Volume
: 8
| Issue : 4 | Page : 202-207 |
Laparoscopically assisted anorectoplasty for high ARM.
RK Raghupathy, PK Moorthy, G Rajamani, V Kumaran, R Diraviaraj, NV Mohan, S Kannan, R Narayanasami, N Babuji, M Natarajan, SG Kandhiya
Department of Pediatric Surgery, Coimbatore, Tamilnadu, India
Correspondence Address:
RK Raghupathy
Department of Pediatric Surgery, Coimbatore, Tamilnadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
ABSTRACT: We operated on 11 patients by LAARP over a 2-year period from March 2001 to February 2003. There were 8 males and 3 females. The age ranged from 2 months to 4 years. Follow up period ranged from 1 month to 2 years. Initially all 11 patients were managed with diverting sigmoid colostomy followed by LAARP. All patients were preoperatively evaluated with ECHO (echocardiogram), USG (ultra sonogram) abdomen, MCU (Micturating Cysto Urethrogram) and distal cologram to assess the cardiac status, genitourinary system and type of fistula. The abdomen was accessed by 3 or 4 ports, with the help of 30 degree telescope; colorectum was dissected up to distal end of the fistula. Fistula was ligated and divided (3 cases) or divided alone (8 cases). Levator Ani Muscle contraction was demonstrated by diathermy probe with low intensity current from above; dissected colorectum was brought down through the centre of the muscle complex in the midline with the help of a laparoscope and external muscle stimulator from the perineum and anoplasty was done. All the patients withstood surgery well. Postoperatively we encountered adhesive intestinal obstruction (1), mucosal prolapse (1) and anal Stenosis (1). Postoperative CT pelvis revealed the rectum is sited within the sphincter complex in all children. Fistula ligation was optional or not obligatory, fecal continence was satisfactory till date. We are presenting the technical aspects of 11 cases LAARP for high ARM from our institute.
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