Laparoscopically Assisted Anorectoplasty for Intermediate-Type Imperforate Anus: Comparison of Surgical Outcomes with the Sacroperineal Approach.

Aim: This study aimed to compare the surgical outcomes of patients with the intermediate-type imperforate anus who underwent laparoscopically assisted anorectoplasty (LAARP; L group) with those of patients who underwent sacroperineal anorectoplasty (S group). Materials and Methods: The medical records of patients with intermediate-type imperforate anus at a single institution between April 1983 and April 2017 were retrospectively reviewed. Fecal continence was evaluated using the clinical assessment score for fecal continence developed by the Japanese Study Group of Anorectal Anomalies (maximum score, 8). Results: Twelve cases (rectobulbar urethral fistula, 7; anal agenesis without fistula, 4; and rectovaginal fistula, 1) were included in the L group versus 14 cases (rectobulbar urethral fistula, 11, and anal agenesis without fistula, 3) in the S group. Age and body weight at the time of surgery and rate of associated anomalies did not differ significantly between the two groups. The total scores for fecal continence 3, 5, and 7 years after anorectoplasty were 4, 5, and 4 points in the L group and 4, 5, and 6 points in the S group, respectively, showing no significant intergroup differences. Mucosal prolapse occurred in 50% of the L group and 29% of the S group (P = .42), but failed rectocutaneous anastomosis and anal stenosis were not identified in either group. Conclusions: Postoperative fecal continence and the incidence of complications after LAARP were comparable with those after sacroperineal anorectoplasty in patients with intermediate-type imperforate anus.

Comparison of Three- and Two-Dimensional Laparoscopy in Pediatric Nissen Fundoplication.

Aim: This study aimed to evaluate the usefulness of three-dimensional (3D) versus conventional two-dimensional (2D) vision in pediatric laparoscopic Nissen fundoplication. Materials and Methods: Medical records and procedure videos of patients 18 years old or younger who underwent laparoscopic Nissen fundoplication at a single institution between January 2015 and August 2018 were retrospectively reviewed. The total pneumoperitoneum and wrapping times were measured. The number of errors during the first stitch of the wrapping was counted. Three-dimensional laparoscopy was introduced in January 2017, and data were compared between the previous 2D and current 3D groups. A questionnaire was provided to each surgeon who performed the 3D procedure. Results: Laparoscopic fundoplication was performed under 2D vision in 32 patients and under 3D vision in 19 patients. Mean ages and weights at surgery were similar between the groups. There was no significant differences in pneumoperitoneum and wrapping times between the two groups. Significantly more errors were counted in the 2D versus 3D procedure, but all patients recovered without any complications related to intraoperative errors. On the questionnaires, all 8 surgeons desired a decreased scope diameter and multidirectional visual axis. Four surgeons (50%) experienced eyestrain and 1 experienced double vision. Conclusions: This study showed no reduction in surgical time with 3D versus 2D scope use. Three-dimensional vision decreased the technical errors in creating the wrap, but its clinical merit remains unclear. Decreasing the scope diameter and adding multidirectional vision capabilities are needed for the 3D scope to gain more widespread approval and use in pediatric surgery.