Long-term results and complications have not yet been described for the laparoscopic approach to imperforate anus, which is a relatively new approach that was developed to avoid a laparotomy and to minimize the posterior sagittal incision . We have managed several complications with this approach, and can anticipate others.
Avoidance of the exposure required to perform the posterior sagittal approach can lead to inadvertent injuries, such as injury to the bladder neck, urethra, or an ectopic ureter. Precise understanding of the anatomic relationships between the pelvis and the laparo-scopic view is vital to avoid these problems. Like the transabdominal approach, there is potential for leaving behind the distal rectal cuff, leading to a posterior urethral diverticulum, particularly for malformations below the peritoneal reflection, such as rectobulbar fistula. Finally, to avoid rectal prolapse, a pelvic hitch is employed; if this step is omitted or done incorrectly, the incidence of prolapse will probably be significant. With the avoidance of the posterior sagittal incision, the described laparoscopic operation omits several key steps of the PSARP that are very important to avoid prolapse , particularly tacking of the posterior rectal wall to the muscle complex.
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