Pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)

What is the pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)?

A laparoscopic pull-through is a minimally invasive procedure to repair several anorectal malformations (ARMs). An ARM is a congenital (present at birth) condition that occurs when a baby’s rectum and anus (lower end of the large intestine) don’t develop properly in the womb.

Laparoscopy allows surgeons to access treatment areas using a few small incisions, a scope (long, narrow instrument with a camera and light) and other specialized instruments.

• Surgeons access the treatment area from the front, through the abdomen (belly), to address abnormal connections between the urinary tract or reproductive organs to the rectum.

• Surgeons then reposition the rectum within the child’s sphincter muscles to create an opening (anus) through which stool (poop) can pass naturally.

What are the benefits of the pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)?

A laparoscopic pull-through procedure can treat several types of ARMs, also called imperforate anus. Our surgeons perform this procedure to create a more normally positioned rectum and anus so that your child can pass stool naturally.

Also called laparoscopic-assisted anorectoplasty (LAARP), this procedure is a minimally invasive procedure that offers certain benefits compared to a laparotomy, which is a larger incision in the belly.

These benefits include:

• Less bleeding

• Less pain after surgery

• A shorter hospital stay and recovery time

What are the risks of the pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)?

Our surgeons and their teams have years of experience performing laparoscopic pull-through surgery on infants and young children, which reduces the rare risk of potential problems. We quickly take steps to protect your child’s health if a problem does occur. Your child’s care team will discuss possible risks of a laparoscopic pull-through surgery with you before the procedure.

In general, risks may include:

• Bleeding from the surgical site

• Infection after surgery

• Reaction to anesthesia (medicine to put your child into a sleeplike state for surgery)

• Excessive pain

• Breakdown of the wound

• Stricture (narrowing) of the new anus

In the long term, children with an ARM may develop constipation or fecal incontinence (soiling and accidents), even with successful laparoscopic pull-through surgery. These children may benefit from our Bowel Management Program.

What to expect with the pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)

Your child may need one or more surgeries over several months to fully repair an ARM, depending on the type. Whenever possible, our skilled surgeons at the Colorectal and Pelvic Center perform a single-stage operation to treat an ARM. We work closely with you and your family to help you understand your child’s condition and create a treatment plan tailored just for them.

What to expect before the pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)

Your child will have had surgery to create a colostomy within days after birth. For a colostomy, the surgeon connects the large intestine to an opening they create in your child’s belly. Your child will have a colostomy bag attached to the opening to collect stool as it exits the body.

With a colostomy, your child can eat and digest as usual. They can also continue to grow before the next surgery, which is the laparoscopic pull-through procedure.

What to expect during the pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)

In the laparoscopic pull-through procedure, the surgeon accesses the pelvic area with a few tiny incisions in the belly. The surgeon inserts a scope and specially designed surgical instruments through the incisions to perform the procedure.

The surgeon corrects any abnormal connections (fistulas) between the rectum and urinary tract or reproductive organs. They separate the rectum from the urinary tract and position it within the sphincter muscles to provide the best chances for bowel control. The surgeon then makes an incision between the buttocks and reconstructs the anus within the sphincter muscles.

What to expect after the pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)

Most children are able to leave the hospital within a few days after a laparoscopic pull-through procedure. You may need to perform anal dilations a few weeks after the procedure to help prevent scar tissue from closing the newly created opening. If so, your child’s care team will show you how to perform dilations. You will need to do them at home until the anal area heals.

Your child’s colostomy will stay in place after the LAARP to allow the anal area to heal before it comes in contact with stool. After the area has healed, our surgeons will close the colostomy. Stool will then pass through your child’s large intestine and out of the body through the rectum and anus.

How do I prepare my child for the pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)?

Your child’s care team will explain how to prepare your child for surgery.

Here are some general steps:

• Children with certain types of ARMs need to go to the hospital the day before surgery for a bowel prep.

• If your child does not need to go to the hospital the day before surgery, the nurse will call you 48 hours (2 days) before the surgery date. They will explain:

  • Guidelines for your child’s food and drink

  • What time you need to arrive at the hospital

• If your child takes medicine, ask the care team whether they should stop or keep taking it before surgery. Do not give your child any medicine on the morning of surgery unless your child’s care team tells you to.

• On the day of surgery, the care team will make sure your child is ready for surgery.

Child Life specialists - We have child life specialists who are here to help your child understand what to expect with having surgery.

What questions should I ask my provider about the pediatric laparoscopic pull-through procedure for anorectal malformations (ARM)?

Some questions you may want to ask your child’s care team include:

• Are there other treatment options for the type of ARM my child has?

• What medications should my child stop taking before laparoscopic pull-through for anorectal malformations?

• How soon will I be able to see my child after the procedure?

• How long will my child need to stay in the hospital after LAARP?

• Will my child go home with any special equipment after LAARP?