Abstract
Introduction:
This video presents a case of coloperineal fistula complicated after posterior sagittal anorectoplasty (PSARP), treated with laparoscopic surgery.
Methods and Materials:
This is a case of anorectal malformation with a rectourethral bulbar fistula, who received colostomy at newborn period. PSARP was fulfilled at the age of 1.5 months. Rectal perforation occurred at 6 month old, which was repaired by laparotomy. However, severe constipation and recurrent urinary tract infection were noted soon after stoma closure at 10 months old. Bowel management was implemented for tackling with bowel issues. Contrast enema showed a coloperineal fistula with complete rectal stricture. Magnetic resonance images revealed the fistula lying between the rectum and the bladder without communication with the urinary tract. The decision was made to perform laparoscopy plus PSARP at the age of 14 months. The patient was put in the supine position with total body preparation. Four ports of 5 mm were placed at the umbilicus, right upper and lower quadrants, as well as left lower quadrant. Severe adhesions were found beneath the stoma and the laparotomy wound, as well as in the pelvis. Lysis of adhesions was accomplished mainly with sharp dissections. The fistula was identified, which joined the anterior wall of rectosigmoid junction. The fistula was divided, followed by colon repair done intracorporeally. Then, the position was changed to the jackknife. A blind rectal pouch was discovered through a posterior sagittal incision. The rectum was mobilized to gain enough length. Multiple stitches were made around the fistula for traction. The dissection was undertaken along the well-epithelialized fistula wall and continued up toward the pelvis. The fistula was completely excised. The dead space occupied by the fistula was closed. Anoplasty was performed with the rectum placed in the central of muscle complex.
Results and Conclusions:
The postoperative recovery was uneventful. The patient had regular bowel movements on a daily basis with no laxative required at the follow-up of postoperative 1 year.
No competing financial interests exist.
Runtime of video: 6 mins 9 secs
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