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Related Experiment Videos

The posterior sagittal trans-sphincteric approach.

A Peña1, A Hong

  • 1Division of Pediatric Surgery. Schneider Children.

Acta Chirurgica Iugoslavica
|March 18, 2005
PubMed
Summary

The posterior sagittal transphincteric approach is a valuable surgical option for pelvic conditions, particularly for complications of Hirschsprung disease and fistulas. It offers good outcomes for bowel and urinary control.

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Area of Science:

  • Surgical Techniques
  • Pelvic Surgery
  • Pediatric Surgery

Background:

  • The posterior sagittal transphincteric approach has been available for over a century but has not achieved widespread popularity.
  • Understanding its historical context and current utility is crucial for surgical decision-making in complex pelvic conditions.

Purpose of the Study:

  • To evaluate the advantages and disadvantages of the posterior sagittal transphincteric approach.
  • To assess its historical significance and the authors' clinical experience.
  • To analyze surgical outcomes, complications, and effects on bowel and urinary control.

Main Methods:

  • Comprehensive literature review of the posterior sagittal transphincteric approach from 1877 to the present.
  • Retrospective analysis of 114 patient cases treated by the authors.
  • Categorization of patients into posterior sagittal transphincteric (Group A, 85 cases) and trans-anorectal (Group B, 29 cases) approaches.

Main Results:

  • Group A treated Hirschsprung disease, presacral masses, rectal tumors, recto-genito-urinary fistulae, and rectal prolapse.
  • Group B treated urogenital sinuses, urethral strictures, and posterior urethral masses.
  • Post-operative bowel and urinary control were maintained, except in cases with pre-existing incontinence or irreversible injury; complications included fistula recurrence and wound dehiscence.

Conclusions:

  • The posterior sagittal transphincteric approach is a technically useful alternative for specific pelvic conditions.
  • It is particularly beneficial for managing complications of Hirschsprung disease, presacral masses, acquired recto-genito-urinary fistulae, and idiopathic rectal prolapse.
  • The trans-anorectal variant offers excellent exposure for posterior urethral and vaginal pathologies without compromising continence.

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