IPEG 2020 TOP ABSTRACT: Transperineal transection for recto-bulbar urethral fistula using a 5-mm stapler in laparoscopic anorectoplasty - A case report of an excellent technique

July 29, 2020
Presenter: Satoshi Ieiri, MA, PhD, FACS
Email: sieiri@m.kufm.kagoshima-u.ac.jp

Authors: Satoshi Ieiri, MD, PhD, FACS; Toshio Harumatsu, MD; Shun Onishi, MD, PhD; Keisuke Yano, MD; Koji Yamada, MD, PhD; Waka Yamada, MD, PhD; Makoto Matsukubo, MD; Mitsuru Muto, MD, PhD; Tatsuru Kaji, MD, PhD; Department of Pediatric Surgery, Kagoshima University

Background:LAARP for recto-bulbar urethral fistula has not become standard practice because of the risk of urethra injury/ incomplete fistula removal. We report a useful technique of transperineal transection using a 5-mm stapler(JustRight) for recto-bulbar fistula.

Operative Procedure:Under general anesthesia, the recto-bulbar fistula orifice was confirmed using flexible cystoscope. Before transection of the fistula, the center of the muscle complex was confirmed from outside. The muscle complex, including the pubo-rectal sling, was then laparoscopically confirmed using electrical nerve stimulator. A pean was inserted to keep the center of the muscle complex from the perineal wound and a 5-mm trocar was replaced. The recto-bulbar urethral fistula was stapled and transected using a 5-mm stapler through the trocar placed at the neo-anus. The operator successfully confirmed complete adequate closure of the fistula under flexible cystoscope observation.

Conclusion: A 5-mm stapler was effective and useful for the recto-bulbar urethral fistula.

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