Analysis Of The Curative Effect Of Laparoscopic Assisted Anoplasty After Colostomy With High Anorectal Malformation

Objective: To summarize the efficacy of laparoscopic assisted anoplasty after primary colostomy for high anorectal malformation and to compare it with open abdominal perineum operation to explore its feasibility and effectiveness.Methods:The clinical data of 43 cases of high anorectal malformation diagnosed in our hospital from September 2011 to January 2017 were retrospectively analyzed.There were10 cases of rectovesical fistula,24 cases of rectourethral fistula,3 cases of rectovaginal fistula,6 cases of non fistula(including 1 case with spherical colon).There were 2 cases of double vagina malformation,1 case with esophageal atresia,7 cases with congenital heart disease,4 cases of Down’s syndrome.all of them underwent colostomy 24 to 72 hours after birth,including 22 cases of descending colostomy and transverse knot.There were 18 cases of enterostomy and 3 cases of sigmoidostomy.From 3 months to 12 months,anoplasty and closure of colostomy were performed in the second stage.There were 20 cases in LAARP group and 43 cases in AP group.The follow-up period from 12 months to36 months,the amount of intraoperative blood loss,operation time,postoperative hospitalization time,postoperative complications(incision infection,urinary fistula,rectal mucosa valgus),Fecal incontinence and anal stenosis were compared with anal function(Kelly score half year and one year after operation).Results:(1)Compared with group AP,LAARP group had less bleeding during operation(15.0ml VS 30.0ml)and shorter postoperative hospitalization time(10.5d VS 15.0d).The difference between the two groups was statistically significant(P<0.05),but there was no significant difference in operative time(176.50 min VS 183.00min)between the two groups;(2)There were 18 cases of postoperative complications in the group of 15 cases with urethral fistula,1 case with anal stricture,4 cases with rectal mucosal valgus,13 cases with incisional infection and fecal incontinence,7 cases with incision infection and 1 case withurinary fistula.Fecal incontinence in 1 case,anal stenosis in 4 cases,rectal mucosal valgus in 4 cases.The incidence of postoperative complications and incision infection were significantly different between the two groups(P < 0.05);(3)Kelly score: the excellent and good rate of LAARP group was 95.0 %(excellent 10 cases,good 9 cases)of AP group73.9%(excellent 6 cases,good 11 cases)half a year after operation.There was no significant difference between the two groups(P > 0.05),but one year after operation,the excellent and good rate of LAARP group was 100.0%(excellent 14 cases,good 6 cases)AP group 78.3%(excellent 8 cases,good 8 cases).There was no significant difference between the two groups(P > 0.05).Conclusion: Laparoscopic assisted secondary anoplasty and closed fistula after colostomy for the treatment of high anorectal malformation,compared with open abdominal perineal surgery,has less bleeding,faster recovery,less postoperative complications,and better defecation function.The treatment period of high anorectal malformation is shortened,and the operation is effective and feasible.