Anorectal Malformation (ARM) with Bladder Fistula: Advantages of a Laparoscopic Approach

Introduction

The recto-bladder-neck fistula in male patients is the only real supralevator muscle malformation and, fortunately, occurs in only about 10 % of cases [2],[3],[4]; 90 % of them are usually associated with urological abnormalities [5]. It is the only defect in male patients that requires a laparotomy in addition to the lower approach for repair, usually performed according to Pena's sagittoplasty [3].

Numerous laparoscopic operations have now replaced the traditional open procedure, allowing access to the abdominal cavity without significantly traumatizing the intervening tissue. In 2000, Georgeson reported his own technique for the repair of high imperforate anus using laparoscopy [1]. The laparoscopically assisted anorectal pull-through (LAARP) makes use of fundamental concepts learned from decades of high ARM repair and combines them with modern advances in surgical instrumentation and techniques [6].

This case report highlights the benefits of laparoscopy for this type of ARM, as it offers a good visualization of the deep pelvis with a reconstruction technique that minimizes trauma to important surrounding structures.

• References

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• 6 Sydorak RM, Albanese CT. Laparoscopic repair of high imperforate anus. Semin Pediatr Surg 2002; 11: 217-225