ABSTRACT
In this chapter, the authors focus on the application of minimal access techniques to the repair of anorectal malformations (ARMs). In general, laparoscopic-assisted anorectal pull-through is most appropriate for high ARMs in boys, including those with rectourethral, prostatic, or bladder neck fistulas, and high imperforate anus without a fistula. Laparoscopy has also been used by several authors for selected forms of cloacal malformations, in order to evaluate the intra-abdominal anatomy and to perform mobilization of pelvic structures. In children with high ARM without a fistula, the decision should be made based on the level of the rectal atresia and surgeon comfort with laparoscopy. If image-guided surgery technique is used, the previously placed magnetic resonance image guided needle is identified at this point. The perineal portion is performed. In short, an incision in the marked and confirmed center of the subcutaneous sphincter complex is made through the dermis.
