Propensity-score matched analysis comparison of robotic and laparoscopic assisted anorectoplasty for anorectal malformation: a multicenter study.

Objective: To explore the efficacy of robotic-assisted anorectoplasty (RAARP) and laparoscopic-assisted anorectoplasty (LAARP) in children with high and intermediate -type anorectal malformations (ARMs).

Methods: This is a post hoc analysis of a multicenter database of high and intermediate -type ARMs patients undergoing RAARP or LAARP at four centers from April 2011 to April 2024. Data on patients' demographics, perioperative outcomes, and postoperative complications were collected. And postoperative defecation function was evaluated by kelly score. Both 1:1 propensity-score matched (PSM) analysis was performed to minimize selection bias between both groups.

Results: A total of 135 cases met the study criteria, of which 48 underwent RAARP and 87 underwent LAARP. Both 1:1 PSM (48 RAARP vs. 48 LAARP) were performed. Both groups were well balanced in the age at anorectoplasty, body weight, type of ARMs, accompanying malformation, and sacral ratio in the matched cohorts by PSM. RAARP group was associated with a significantly shorter operative time compared with LAARP group, less blood loss, and shorter postoperative hospital stay (P < 0.05). There were no significant differences in terms of postoperative complications and defecation function Kelly score between two groups (P > 0.05). On subset analysis of 93 patients with rectourethral fistula and 53 patients with rectobulbar fistula, RAARP was associated with significantly shorter operation time, less blood loss compared to LAARP group (P < 0.05), and better soiling control effect in rectourethral fistula and enhanced superior Kelly scores for defecatory function in rectobulbar fistula incompared to LAARP group (P < 0.05).

Conclusion: RAARP is a safe and effective operation for the treatment of high and intermediate-type anorectal malformation, which may be more suitable for rectourethral fistula.