Intraoperative Sonographic Guided Pull-through Anorectoplasty: A Novel Procedure for Imperforate Anus and Rectourethral Fistula: A Clinical Trial Study

Joudi, Marjan; Fathi, Mehdi; Sabzevari, Alireza; Nazarzadeh, Reza; Hassani, Mohammad Hossein; Azadmand, Ali; Mohammad-pour, Ahmad; Jamali-Behnam, Farideh; Ziaee-mehr, Aghigh; Alamdaran, Seyed Ali; Parvizi Mashhadi, Mahdi; Vaziri, Saeed; Alizadeh, Khalil; Keshtgar, Alireza

doi:10.22038/ijp.2017.23287.1966

Intraoperative Sonographic Guided Pull-through Anorectoplasty: A Novel Procedure for Imperforate Anus and Rectourethral Fistula: A Clinical Trial Study

Authors

¹ Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.

² Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

³ Surgical Oncology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

⁴ Division of Radiology, Department of Pediatrics, Dr. Sheikh Children Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

⁵ Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

⁶ Department of Pediatric Surgery, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK.

10.22038/ijp.2017.23287.1966

Abstract

Background and objectives: Optimal surgical management of the neonate with imperforate anus (IA) depends on determining accurate location of muscle complex, pouch of rectum and urethral fistula. The aim of this study was to investigate a novel minimally invasive technique of anorectoplasty assisted by intraoperative sonography pull-through for repair of anorectal malformation and rectourinary fistula.
Patients and methods: Eight male patients with imperforate anus aged under 48 h had undergone colostomy. Any associated anomalies were evaluated in cases. After 5-8 weeks, neonates were prepared for anoplasty. After catheterization, sonography of perinea was carried out. Patients were placed in lithotomy position. The accurate position of each required point was determined by this procedure.
Results: In all cases, the pouch of rectum to skin distance was in range 1.5-1.8 mm and entrance distance of wire to fistula was maximally 6 mm, just in one patient this value was 7 mm. Anomalies associated with some patients were Down Syndrome, cardiac anomalies, kidney disease .6 out of 8 patients removed urinary catheter after two days and discharged home. Colostomy of all patients was closed after sonography of prinea. After one week and one month follow- up, all patients had an acceptable fecal frequency about 3- 5 times a day.
Conclusion:Intra-operative sonography is an applicable procedure to determine correct location of muscle complex, pouch of rectum and uretral fistula to treat IA patients non- invasively. Another interesting point of this study is the ability of non invasive surgery and novel procedure with perfect result.

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