Challenging the standard: comparison of outcomes between laparoscopically assisted anorectoplasty (LAARP) and posterior sagittal anorectoplasty (PSARP) in the correction of rectobulbar fistula in pediatric patients.

BACKGROUND

Posterior sagittal anorectoplasty (PSARP) remains the standard surgical approach for rectobulbar fistula in patients with anorectal malformations (ARM). Laparoscopically assisted anorectoplasty (LAARP) has emerged as an alternative technique, although its role in rectobulbar fistula remains controversial.

OBJECTIVE

To compare surgical and functional outcomes of LAARP and PSARP in pediatric patients with ARM and rectobulbar fistula.

METHODS

A retrospective cohort study was conducted including male patients with rectobulbar fistula who underwent repair at a tertiary pediatric surgery center between 2000 and 2024. Patients were grouped according to surgical technique (LAARP vs. PSARP). Perioperative outcomes, postoperative complications, functional outcomes assessed using the Krickenbeck classification, and reintervention rates were analyzed.

RESULTS

Fifty-three patients met inclusion criteria (19 LAARP, 34 PSARP). Patients undergoing LAARP were significantly younger at the time of repair (median 8 vs. 17 months, p = 0.006). Overall postoperative complication rates did not differ significantly between groups (26.3% vs. 47.0%, p = 0.158). Functional outcomes and late complications were comparable. A non-significant trend toward fewer postoperative complications was observed in the LAARP group.

CONCLUSIONS

LAARP and PSARP provide comparable functional outcomes for rectobulbar fistula repair. LAARP appears to be a safe alternative in selected patients when performed in experienced centers.