Transanal ligation of fistula during laparoscopically assisted anorectal pull-through for rectourethral bulbar fistula-a case series.

Background: Rectourethral fistulae (RUFs) are common in boys with anorectal malformations (ARMs). Laparoscopically assisted anorectal pull-through (LAARP) is the preferred approach for treating high/intermediate imperforate anus RUF; however, its application for rectourethral bulbar fistula (RUBF) is contentious due to worries about the remnant of the original fistula (ROOF). Our primary objective is to present the surgical technique for transanal ligation of RUBF and to discuss its merits in mitigating urethral complications related to a ROOF for LAARP surgery. Case Description: Following the complete isolation of the distal RUF during LAARP surgery, a silk thread was introduced into the pelvic region through an anal tunnel within the established sphincter complex. This thread was used to encircle and securely ligate the RUF. This retrospective analysis encompassed four children with RUF who underwent transanal ligation during LAARP surgery between October 2019 and December 2022. We looked at patient demographics, perioperative variables, and the outcomes of the follow-up. Their median age was 65 (range, 52-115) days, the median duration of each procedure was 115 (range, 100-130) minutes. Postoperatively, the catheter was retained for 8 days. Hospital stay also lasted 8 days. In the follow-up patients had normal bowel and urinary tract function without complications such as ROOF, urethral tract injury, anal stenosis or rectal prolapse. Conclusions: The LAARP surgical technique of transanal fistula ligation proved to be feasible and promising for treatment of RUBF. It enhances the precision of fistula ligation and can reduce the incidence of urologic complications.