Current practice of diagnosis and treatment for rectourethral fistula in male patients with anorectal malformation: a multicenter questionnaire survey in Japan.
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Abstract
Purpose: Surgical procedures for anorectoplasty for anorectal malformations (ARMs), particularly rectourethral fistula (RUF), depend on the institution. We investigated the diagnosis and treatment of RUF in male patients with ARMs in Japan using a questionnaire survey.
Methods: An online survey inquiring about the diagnosis and treatment (diagnostic modalities, surgical approaches, fistula dissection devices, and fistula closure techniques) of each type of ARM in male patients was conducted among institutional members of the Japanese Study Group of Anorectal Anomalies. Fisher's exact test was used to compare surgical methods between posterior sagittal anorectoplasty (PSARP) and laparoscopy-assisted anorectoplasty (LAARP).
Results: Sixty-one institutions (100%) completed the survey. LAARP was the preferred approach for high-type ARM (75.4%). PSARP was preferred for intermediate-type ARM (59.0%). Monopolar devices were most commonly used (72.1%) for RUF dissection. Blunt dissection was more frequent in the PSARP group (PSARP vs. LAARP: 55.6 vs. 20.0%, p < 0.005). Cystoscopy/urethroscopy to confirm the extent of dissection was used more frequently in the LAARP group (70.0% vs. 25.0%, p < 0.005). Clips and staplers were used more frequently in the LAARP group (p < 0.05).
Conclusion: Distinct fistula management strategies for PSARP and LAARP were revealed. Further studies are needed to investigate the postoperative outcomes associated with these practices.
目的：肛门直肠畸形（ARM），尤其是直肠尿道瘘（RUF）的肛门成形术的手术程序取决于不同的医疗机构。我们采用问卷调查的方式调查了日本男性肛门直肠畸形患者的 RUF 诊断和治疗情况：方法：我们对日本肛门直肠畸形研究小组的机构成员进行了一项在线调查，询问了男性患者中各种类型 ARM 的诊断和治疗情况（诊断方式、手术方法、瘘管剥离装置和瘘管闭合技术）。采用费雪精确检验比较了后矢状肛门直肠成形术（PSARP）和腹腔镜辅助肛门直肠成形术（LAARP）的手术方法：结果：61家机构（100%）完成了调查。LAARP是高类型ARM的首选方法（75.4%）。中型 ARM 首选 PSARP（59.0%）。单极设备最常用于 RUF 剥离（72.1%）。钝性剥离在 PSARP 组更为常见（PSARP vs. LAARP：55.6% vs. 20.0%，P 结论：PSARP和LAARP的瘘管处理策略有所不同。需要进一步研究与这些方法相关的术后结果。
期刊介绍：
Pediatric Surgery International is a journal devoted to the publication of new and important information from the entire spectrum of pediatric surgery. The major purpose of the journal is to promote postgraduate training and further education in the surgery of infants and children.
The contents will include articles in clinical and experimental surgery, as well as related fields. One section of each issue is devoted to a special topic, with invited contributions from recognized authorities. Other sections will include:
-Review articles-
Original articles-
Technical innovations-
Letters to the editor
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