Laparoscopic-assisted colostomy with anorectal malformation: friend or foe?

Abstract Purpose The standard management of anorectal malformations (ARM) without perineal fistula involves fecal diversion via a sigmoid colostomy. This report aims to describe our initial experience and evaluate the feasibility and benefits of laparoscopically-assisted loop colostomy in a neonate with ARM without perineal fistula, addressing the question of whether this minimally invasive approach offers advantages over traditional open techniques. Methods We report the case of a full-term male newborn with an imperforate anus. A laparoscopic-assisted loop colostomy was performed on the second day of life. Three trocars were used: a 5 mm umbilical port for the laparoscope and two 3 mm ports on the flanks. The surgical technique, including trocar placement, bowel mobilization, stoma creation, and closure, is described. The postoperative course and long-term outcomes were monitored over 17 months, including subsequent anorectoplasty and stoma closure. Results The laparoscopic approach provided superior visualization of pelvic anatomy, enabling accurate identification of the fistula and optimal stoma placement. Postoperatively, the patient exhibited early stoma function, rapid recovery, and no complications such as urinary tract infections or stomal issues. Follow-up procedures, including anorectoplasty and colostomy closure, were performed without incident. The patient remains healthy and complication-free at 17 months of age Conclusion Laparoscopic-assisted colostomy offers distinct advantages over the open technique, including reduced complications, improved recovery, and favorable cosmetic outcomes. This minimally invasive method represents a promising alternative for ARM management, aligning with modern pediatric surgical advancements.