Does the posterior sagittal approach with perirectal dissection impair fecal continence in a normal rectum?

The aim of this study was to determine, using human material and animal experiments, whether the posterior sagittal approach with perirectal dissection (PSAPD) in patients with an intact anorectum is a suitable means of exposure for the correction of complicated anomalies of the genitourinary tract without impairment of fecal continence. Over the last 6 years, the authors have performed PSAPD in seven children with an intact anorectum. At the time of operation, their ages ranged from 8 months to 14 years. All patients showed normal fecal continence at the end of follow-up (averaging 32 months). Only after completion of the study did the authors read that Peña et al had found that PSAPD provoked severe changes in bowel control in dogs. This contradiction prompted the authors to repeat the animal experiments, and they could not reproduce the favorable results obtained in children. This might be explained by the following factors: the surgical dissection used in the dogs was more extensive, anatomic differences between man and dog, the relatively much younger age of the animals (versus the patients), and the shorter follow-up and lack of educability of the dogs. The authors conclude that PSAPD is a suitable approach for selected lesions of the genitourinary tract in children who have a normal rectum and it does not impair fecal continence.