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

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Abstract

BACKGROUND: Anorectal abnormalities occur in 1:1,500 to 1:5,000 live births. There is still no agreement on the best surgical procedure for treating some types of anorectal abnormalities in males. Anorectoplasty could be performed using the posterior sagittal approach and using laparoscopic techniques.

AIM: To assess the risk of postoperative complications and determine their specificity in males with anorectal malformations, depending on the surgery approach.

MATERIALS AND METHODS: A single-center retrospective cohort study was performed. Male patients with anorectal malformations who had surgical correction of anorectal malformation by posterior sagittal (group I) or laparoscopic-assisted anorectoplasty (group II) at the age of up to 1 yr at the N.F. Filatov Children’s City Clinical Hospital from 2008 to 2022. Postoperative and intraoperative problems and the number of surgical interventions that had to be redone to correct issues were noted.

RESULTS: Of the 33 patients in group I, 18 (55%) had anorectal malformations with bulbar fistula, 12 (36%) had anorectal malformations without fistula, and three (9%) had a prostatic fistula. Group II included 99 patients, with 53 (54%) having anorectal malformations with prostatic fistula, 30 (30%) having anorectal malformations with bulbar fistula, nine (9%) having anorectal malformations with bladder neck fistula, and seven (7%) having anorectal malformations without a fistula. The incidence of intraoperative and postoperative complications was statistically significantly higher in children after posterior sagittal anorectoplasty than laparoscopic-assisted anorectoplasty: I, 19 (58%) versus II, 33 (33%); p = 0.014. The number of redo surgical interventions to correct complications did not differ significantly between the studied groups: I, 8 (24%) versus II, 26 (26%); p = 0.819. The incidence of urethral damage was identified with posterior sagittal anorectoplasty compared with laparoscopic-assisted anorectoplasty: I, 4 (12%) versus II, 0 (0%); p < 0.001. We found no differences in postoperative complications between 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 necessary to develop clear criteria for rectum mobilization and the volume of rectourethral fistula dissection during laparoscopic-assisted surgery to reduce the risks of postoperative problems and repeat surgery.

About the authors

Dmitrii D. Morozov

Pirogov Russian National Research Medical University; N.F. Filatov Children’s City Clinical Hospital

Author for correspondence.
Email: dr.dd.morozov@gmail.com
ORCID iD: 0000-0002-9115-7008
SPIN-code: 2982-1785

Postgraduate Student, Pediatric Surgeon

Russian Federation, Moscow; Moscow

Anzhelika E. Agavelyan

Pirogov Russian National Research Medical University

Email: lika.lk@mail.ru
ORCID iD: 0009-0005-5361-8589

Student

Russian Federation, Moscow

Rashid V. Khalafov

Pirogov Russian National Research Medical University; N.F. Filatov Children’s City Clinical Hospital

Email: drrash777@gmail.com
ORCID iD: 0000-0001-7998-5639
SPIN-code: 7141-9649

MD, Cand. Sci. (Med.), Assistant

Russian Federation, Moscow; Moscow

Vasiliy S. Shumikhin

Pirogov Russian National Research Medical University; N.F. Filatov Children’s City Clinical Hospital

Email: pennylane@yandex.ru
ORCID iD: 0000-0001-9477-8785
SPIN-code: 6405-8928

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Moscow; Moscow

Olga G. Mokrushina

Pirogov Russian National Research Medical University; N.F. Filatov Children’s City Clinical Hospital

Email: mokrushina@yandex.ru
ORCID iD: 0000-0003-4444-6103
SPIN-code: 5998-7470

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

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Supplementary files

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2. Fig. 1. The severe rectal prolapse in a patient after laparoscopic-assisted anorectoplasty

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3. Fig. 2. Remnant of original fistula in a patient after laparoscopic-assisted anorectoplasty

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4. Fig. 3. The duration of the operation (a) and the length of stay in the hospital in the postoperative period (b). I, posterior sagittal anorectoplasty; II — laparoscopic-assisted anorectoplasty. *p < 0,05

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