Rectal atresia: transanal, end-to-end, rectorectal anastomosis: a simplified, rational approach to management

Transanal, end-to-end, rectorectal anastomosis (TERA) is a new technique for the surgical correction of rectal atresia. Hitherto performed abdominoperineal or sacroperineal procedures entailed major traumatizing surgery with an inherent risk of complications. The rationale of TERA is based on three factors: (1) the anorectal canal distal to the atresia is normally developed, as are the sphincteric muscles surrounding it; (2) the anorectum can be preoperatively dilated to allow a transanal anastomosis of good size; and (3) the atretic segment can be effectively "intussuscepted" into the anal canal, almost up to the anal verge, by an oversized metal bougie passed through the sigmoid colostomy. A midline sagittal incision over the metal bougie exposes the rectal pouch, which is mobilized from the surrounding muscle fibers, and a direct, end-to-end anastomosis is performed. This technique has been successfully used in two cases of rectal atresia having a gap between the two pouches.