الفهرس 
Contents
Embryology of the hindgutOnly 14 pages are availabe for public view
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Abstract
Introduction: LAARP has been gaining great popularity for management of imperforate anus. This study aims to evaluate the use of this technique for high and intermediate ARMs in boys. Methods: from December 2012 to December 2016 we performed LAARP on 20 boys all of which were colostomised at birth. Findings as regards the patients’ age at operation, type of anomaly, associated morbidities, sacral ratios, operative time, intra-operative complications, hospital stay, immediate/long term post-operative complications and reoperations were noted. Post-operatively we evaluated the patients using barium enema, an ascending and voiding cystourethrogram (ACUG & VCUG), pelvic MRI and a functional continence evaluation questionnaire (FEQ). Results: 11 patients presented with recto-urethral bulbar fistula (RBF), 7 with recto-urethral prostatic fistula (RPF), 1 with recto-vesical fistula (RVF) and 1 with no fistula. Mean sacral ratio was 0.82+/-0.19. Mean age at time of LAARP was 236+/-77 days. Mean operative time was 152+/-32mins. Our most common intraoperative complication was peritoneal contamination (20%). Incidence of rectal mucosal prolapse was 40%. Barium enema revealed a mean RAA of 107+/-13 degrees. ACUG and VCUG revealed a residual urethral diverticulum (RUD) in 7 cases, 6 of which had RBFs. Mean MRI placement score obtained was 0.76+/-0.51 denoting excellent rectal position. Conclusion: Using LAARP to manage high and intermediate ARMs in boys is feasible allowing accurate rectal placement within the muscle complex and with good post-operative functional results. RUD occurred more frequently in RBF patients. Incidence of mucosal prolapse is high after LAARP and should be avoided.