Single port laparoscopic assisted anorectal pull-through in anorectal malformation
Epublication WebSurg.com, Sep 2014;14(09). URL: http://websurg.com/doi/vd01en4321
This is the case of a 21-month-old male infant, referred from another center, with anorectal malformation and rectourethral fistula. The patient underwent a colostomy two months earlier and weighed 10Kg. On physical examination, the intergluteal cleft is evident, the infant has a good anal fovea, and his coccyx is palpable. In the distal colostogram, the distance between the rectum and the anus is approximately 2.7cm. The patient underwent single port laparoscopic anorectal pull-through, using the GelPOINT® Mini advanced access platform at umbilical level and a 3mm accessory port was placed at left upper quadrant level. Dissection of the distal part and division of the fistula by a white cartridge 45mm and 10mm ECHELON™ Hem-o-Lok® to remove the fistula at the level of the membranous urethra. A 5mm trocar was placed at the level of the fovea anal and rectum is lowered. The length of the procedure was approximately 3 hours and the patient was discharged on postoperative day 3, and progressed satisfactorily. One advantage of the use of the GelPOINT® Mini advanced access platform is that it allows the introduction of a larger number of instruments of different diameters (3 to 15mm) through the GelSeal® cap without placing other working ports. The single port laparoscopic anorectal pull-through procedure seems to be an efficient method that allows for adequate visualization and tissue manipulation in these patients.