Intraoperative measurement of rectourethral fistula: prevention of incomplete excision in male patients with high-/intermediate-type imperforate anus Hiroyuki Koga, Yoshifumi Kato, Akihiro Shimotakahara, Go Miyano, Geoffrey J. Lane, Tadaharu Okazaki, Atsuyuki Yamataka ⁎ Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo 113-8421, Japan Received 23 October 2009; accepted 27 October 2009 Key words: Imperforate anus; Rectourethral fistula; Laparoscopically assisted anorectal pull-through; Posterior urethral diverticulum Abstract Introduction: We report a novel technique to measure the length of the rectourethral fistula (RUF) in male patients with high-/intermediate-type imperforate anus during laparoscopically assisted anorectal pull-through (LAARP) to prevent incomplete excision. Method: During LAARP for RUF in 5 male patients (mean age, 4.6 months; prostatic in 3, bulbar in 2), the RUF was dissected carefully close to the urethra and opened; and a fine catheter with 10-mm calibrations was inserted by the laparoscopic surgeon until it was seen to emerge at or near the verumontanum by another surgeon performing cystoscopy. The laparoscopic surgeon then measured the distance from the point where dissection was ceased at the rectal end to the urethral orifice. The RUF was dissected free from the prostate for exactly this length, tied, and excised; and colon pull-through was performed to finish LAARP. Result: Rectourethral fistulae ranged from 5 to 15 mm and were much longer than expected. All dissections were uncomplicated without any injury to the urethra, and postoperative courses were unremarkable. At mean follow-up of 11 months, urination is normal in all without evidence of residual fistula. Conclusion: Knowing the exact length of the RUF facilitates safe and complete excision in an otherwise blind situation. © 2010 Elsevier Inc. All rights reserved. Laparoscopically assisted anorectal pull-through (LAARP), first described by Georgeson et al [1], is now considered to be one of the radical surgical treatments of choice for rectourethral fistula (RUF) in male patients with high-/intermediate-type imperforate anus. Recently, there have been reports about diverticulum formation secondary to incomplete excision of RUF during LAARP [2-5]; and as a result, complete excision, while technically challenging, is now regarded as crucial. The aim of this study was to describe a novel technique to facilitate complete excision of RUF in male patients with high-/intermediate-type imperforate anus. Presented at the 56th Annual Meeting of the British Association of Paediatric Surgeons, Graz, Austria, June 18-20, 2009. ⁎ Corresponding author. Tel.: +81 3 3813 3111; fax: +81 3 5802 2033. E-mail address: yama@juntendo.ac.jp (A. Yamataka). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2009.10.085 Journal of Pediatric Surgery (2010) 45, 397–400