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[Posterior sagittal anorectoplasty (PSARP) in children with high anal atresia]
B Zupancić1, A Antabak, L Popović
1Klinicki bolnicki centar Zagreb, Klinika za kirurgiju Medicinskog fakulteta Sveucilista u Zagrebu.
Insights
Anorectal anomalies, affecting 1 in 3000 infants, pose significant challenges. The Pena-de Vries method (PSARP) has improved fecal continence rates in children with high supralevator anomalies.
Area of Science:
- Pediatric Surgery
- Developmental Biology
Context:
- Anorectal anomalies are a significant congenital condition affecting approximately 1 in 3000 infants.
- High supralevator anorectal anomalies historically presented with high rates of fecal incontinence (50-80%) despite surgical efforts.
- Advancements in surgical techniques aim to reconstruct pelvic anatomy and improve functional outcomes.
Purpose:
- To evaluate the efficacy of the Pena-de Vries method (Posterior Sagittal Anorectoplasty - PSARP) in achieving fecal continence in children with high supralevator anorectal anomalies.
- To assess the functional outcomes of PSARP in a cohort of pediatric patients, focusing on continence rates.
Summary:
- The Pena-de Vries method (PSARP), introduced in 1982, utilizes electrical stimulation to precisely identify and reconstruct the anorectal sphincter complex.
- This surgical approach involves mobilizing and modeling the rectum for insertion into the identified muscle-sphincter complex.
- A ten-year study of 15 children (14 boys, 1 girl) who underwent PSARP, with a focus on those with rectourethral and rectovaginal fistulas and associated anomalies, demonstrated a 67% continence rate in children over 3 years old.
Impact:
- The PSARP technique represents a significant advancement in the surgical management of high anorectal anomalies.
- Improved surgical reconstruction has led to better functional outcomes, specifically enhancing fecal continence in affected children.
- This study highlights the potential of PSARP to improve the quality of life for children born with complex anorectal malformations.
Abstract:
Anorectal anomalies are highly significant (the incidence of 1:3000 infants). The knowledge of the factors related to fecal continence encouraged the introduction of new surgical approaches in the second half of this century. With high supralevator anorectal anomalies the percentage of incontinence in children was earlier 50-80% although in all surgical procedures efforts were made to reconstruct the normal anatomy of the small pelvis. It was only in 1982 that by the PSARP method the anatomic reconstruction was achieved. In this operation an electric stimulator is used to identify the entire muscle-sphincter complex (external sphincter, the cross-striated muscle complex and the levator musculature) and then by stimulation of muscles a mobilized and modeled rectum is inserted into the muscle-sphincter complex. During the ten-year application of the PSARP method 15 children underwent the operation, of which 14 boys and 1 girl. The girl had rectovaginal fistula and 11 boys had rectourethral fistula. More than 70% of our children showed accompanying anomalies. Control examinations of children older than 3 years show the 67% continence in our children operated by the Pena-de Vries method.
