Intraoperative measurement of rectourethral fistula: prevention of incomplete excision in male patients with high-/intermediate-type imperforate anus.

Abstract:

INTRODUCTION:We report a novel technique to measure the length of the rectourethral fistula (RUF) in male patients with high-/intermediate-type imperforate anus during laparoscopically assisted anorectal pull-through (LAARP) to prevent incomplete excision. METHOD:During LAARP for RUF in 5 male patients (mean age, 4.6 months; prostatic in 3, bulbar in 2), the RUF was dissected carefully close to the urethra and opened; and a fine catheter with 10-mm calibrations was inserted by the laparoscopic surgeon until it was seen to emerge at or near the verumontanum by another surgeon performing cystoscopy. The laparoscopic surgeon then measured the distance from the point where dissection was ceased at the rectal end to the urethral orifice. The RUF was dissected free from the prostate for exactly this length, tied, and excised; and colon pull-through was performed to finish LAARP. RESULT:Rectourethral fistulae ranged from 5 to 15 mm and were much longer than expected. All dissections were uncomplicated without any injury to the urethra, and postoperative courses were unremarkable. At mean follow-up of 11 months, urination is normal in all without evidence of residual fistula. CONCLUSION:Knowing the exact length of the RUF facilitates safe and complete excision in an otherwise blind situation.

journal_name

J Pediatr Surg

authors

Koga H,Kato Y,Shimotakahara A,Miyano G,Lane GJ,Okazaki T,Yamataka A

doi

10.1016/j.jpedsurg.2009.10.085

subject

Has Abstract

pub_date

2010-02-01 00:00:00

pages

397-400

issue

2

eissn

0022-3468

issn

1531-5037

pii

S0022-3468(09)00884-7

journal_volume

45

pub_type

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