Feasibility and safety of laparoscopic versus open repair for rectobulbar fistula in anorectal malformations: A systematic review and meta-analysis.

BACKGROUND

Laparoscopic-assisted Anorectoplasty (LAARP) for male recto-bulbar fistula (RBF) remains debated, with early reports describing approach-specific complications. Prior meta-analyses pooled heterogeneous Anorectal malformation (ARM) subtypes, limiting conclusions for RBF. We conducted an RBF-specific systematic review and meta-analysis comparing LAARP with posterior sagittal anorectoplasty (PSARP).

METHODS

PubMed/MEDLINE, Embase, Scopus, and Google Scholar were searched (2000-November 2025) for comparative studies of LAARP versus PSARP in male children with RBF. Risk of bias was assessed using the ROBINS-I tool. Random-effects meta-analyses in Jeffreys's Amazing Statistics Program (JASP) used log effect sizes for dichotomous outcomes and mean differences for operative time. Sensitivity analyses excluded studies with zero events in both arms.

RESULTS

Six observational cohort studies (278 patients; LAARP 154, PSARP 124) were included. No intraoperative complications or conversions to open surgery were reported. Postoperative urethral diverticulum (UD) was not reported in five studies; one study reported 4 cases (15.38 %) after LAARP and none after PSARP, precluding meta-analysis. Primary analyses showed no statistically significant differences between LAARP and PSARP for residual fistula (RSF) (pooled log odds ratio (OR) 0.68, 95 % confidence interval (CI) -0.86 to 2.22), anal stenosis (log OR -0.36, 95 % CI -1.35 to 0.63), or rectal prolapse (log OR 1.03, 95 % CI -0.03 to 2.09). Reoperation was infrequent but higher after LAARP in the pooled analysis (log OR 1.23, 95 % CI 0.02 to 2.44); this persisted in event-positive studies (log OR 1.45, 95 % CI 0.18 to 2.72). Operative time was longer with LAARP (mean difference (MD) 66.74 min, 95 % CI 27.48 to 106.00), with substantial heterogeneity (I2 97.57 %). Wound infection was uncommon and inconsistently reported; quantitative pooling was not undertaken.

CONCLUSIONS

LAARP is a feasible and safe option for male RBF, with outcomes comparable to those of PSARP for major postoperative complications; however, the certainty of the evidence remains limited, underscoring the need for high-quality prospective studies.