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Results after posterior sagittal anorectoplasty: a new approach to high imperforate anus
Insights
Posterior sagittal anorectoplasty in infants with high imperforate anus and rectourethral fistula yielded positive outcomes. The de Vries and Pena technique achieved normal continence and rectal sensation in most young patients.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Congenital Anomalies
Background:
- High imperforate anus with rectourethral fistula is a complex congenital condition requiring surgical correction.
- Early surgical intervention is crucial for optimal functional outcomes in affected infants.
Purpose of the Study:
- To evaluate the efficacy and safety of posterior sagittal anorectoplasty using the de Vries and Pena technique in infants with high imperforate anus.
- To assess functional outcomes, including continence and anorectal manometry, following the surgical procedure.
Main Methods:
- Six infants (3-12 months) with high imperforate anus and rectourethral fistula underwent posterior sagittal anorectoplasty.
- The de Vries and Pena method, incorporating electrostimulation and external sphincter identification, was employed.
- Serial assessments and anorectal manometry were conducted post-operatively.
Main Results:
- No operative complications were reported in the series.
- Three out of six patients achieved normal fecal continence.
- Four out of five patients demonstrated normal rectal sensation and anal canal pressures on manometry.
Conclusions:
- Posterior sagittal anorectoplasty, particularly the de Vries and Pena technique, is a viable surgical option for young infants with high imperforate anus and rectourethral fistula.
- Satisfactory functional results, including continence and sensory/pressure parameters, can be anticipated with this approach.
Abstract:
Six patients, 3 to 12 months of age have undergone posterior sagittal anorectoplasty for high imperforate anus. A rectourethral fistula was present in all patients. The operative procedure performed was the method of de Vries and Pena, utilizing electrostimulation and identification of the external sphincter muscles. One patient required an abdominal operation as well as the perineal approach. There were no complications. Serial assessment was carried out over a period of 4 months to 2 1/2 years. Normal continence was achieved in three patients. Anorectal manometry was performed in five patients. Four of five patients had normal rectal sensation and normal mean anal canal pressures. These results suggest that this procedure is applicable to the young infant with high imperforate anus, and a satisfactory result can be anticipated.