Technical modifications of laparoscopically assisted anorectal pull-through for anorectal malformations.

PURPOSE: Our technique of fistula ligation and centering of bowel during the laparoscopically-assisted anorectal pull-through (LAARP) for the high-imperforate anus is described.

METHODS: The distal rectum is dissected laparoscopically. About 1 in proximal to the termination of the rectum, we commence a subseromuscular dissection to create a mucosal tube of the distal rectum up to the urethra. This mucosal tube is then ligated and sharply divided. Under laparoscopic guidance, the needle is inserted between the two bellies of Levator Ani muscle, just posterior to the urethra. Simultaneous external stimulation confirms the optimal position. A guide wire is then passed through the needle. The tract is serially dilated and the anoplasty completed.

RESULTS: This technique has overcome the problem of residual urethral diverticulum in our cases.