Posterior sagittal anorectoplasty [PSARP]. A new approach for treating anorectal malformations

ABSTRACT

Anorectal malformation is a congenital anomaly of different varieties and its correction needs good experience, knowledge about this varieties and specific surgical tools, otherwise the child may lose his the only chance to live normally without disastrous complication like incontinence. assessment of the advantage of this procedure in management of anorectal malformations and the percentage for anal continence. This study was carried out in the child's central teaching hospital in Baghdad total number [70] cases were included in the study, 37 males and 33 females aged 7 days to 6 years. They attended the hospital between October 1998-october 2004.* Male defect included 1] Low type....5 cases No colostomy needed. 2] Intermediate type....23 cases, needed colostomy. 3] High type.... 9 cases needed colostomy. Female defects 1] Imperforate anus with vestibular fistula-31 cases. 2] Imperforate anus without fistula 2 cases. From the study we gain the following results- all the male patients with low and intermediate types 28 cases [40%] show 100% continence. All female patients with imperforated anus with vestibular fistula and without fistula 33 cases [47%] show 100% continence. The combination of male and female patients show 61 patients of 70 show 100%continence in a percentage of 87%. The nine cases [12.85%] with recto bladder neck fistula show poor continence due to their bad sacral contour associated with the poor development of pelvic muscles sphincter. This result was revealed from follow-up together with the presence of external sphincter muscle contraction which occurs during digital PR examination or by the use of surgical dilators. From the study we found that this procedure gives high percentage of continence and should be used instead of other procedures