Transurethral migration of surgical clips following laparoscopic-assisted anorectoplasty (LAARP): A case report

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Introduction Fistula division during laparoscopic-assisted anorectoplasty (LAARP) for anorectal malformations (ARM) may be achieved with sutures, staplers, energy devices, clips, or simple transection. Although laparoscopic clip ligation is quick and hemostatic, clip migration is a recognized complication in other procedures, including cholecystectomy and tracheoesophageal fistula repair. Case presentation A 5-month-old male with rectoprostatic fistula underwent LAARP with laparoscopic dissection and two titanium clips for ligation of the fistula, followed by rectal pull-through. Early recovery was uneventful, but caregivers two months later noted new-onset straining during micturition. Before stoma closure, an examination under anaesthesia was performed to assess the anoplasty post-LAARP and to conduct a cystoscopy to evaluate this recent complaint. Cystoscopy demonstrated a metallic clip at a minute residual opening of the original rectourethral fistula in the prostatic urethra; the narrow tract did not permit safe passage of instruments, so observation was elected. Six months after LAARP, the parents reported spontaneous passage of two titanium clips on consecutive days during micturition, with complete resolution of urinary straining. A subsequent abdominal radiograph confirmed the absence of radiopaque clips in the pelvis. Conclusion Transurethral migration of clips used for the ligation of a rectourethral fistula is possible. The use of clips near the urinary tract should be balanced against the potential risk of migration. Alternatives such as intracorporeal suturing or stapling should be considered.