Posterior sagittal anorectoplasty for imperforate anus: a preliminary result

Posterior Sagittal Anorectoplasty (PSARP) is a new technique which was pioneered by Pena and de Vries in 1982 for the repair of high anorectal malformations. It is based upon complete exposure of the anorectal region by means of a median sagittal incision that runs from the sacrum to the anal dimple cutting all muscle structures behind the rectum. The incision is kept in the median plane using a muscle or nerve stimulator as a guide. Between March 1988 and April 1989, we operated on 10 patients who had high and intermediate types of imperforate anus according to the "Wingspread Classification". All of the patients had PSARP as the definitive operation. The age of the patients were between 1.5 months and 15 years at the time of operation, four were under six months. Nine patients had this operation as the primary procedure, one patient had re-pullthrough after failure to gain continence by a previous conventional abdomino-perineal pullthrough operation. Six out of 8 patient had good results, two patients had fair results according to Kiesewetter's clinical criterion for fecal continence. Two patients are waiting for colostomy closure and are yet to be evaluated. Two of the good results included a 15-year-old girl who had high type with rectovaginal fistula, and a 2-month-old male infant with a recto-urethral fistula. In a re-pullthrough patient, the continence, as evaluated by loopogram and defecogram through the colostomy before closure of the colostomy, is good.(ABSTRACT TRUNCATED AT 250 WORDS)