Abstract
Background The posterior sagittal anorectoplasty (PSARP) used to repair an anorectal malformation
(ARM) with a rectovestibular fistula involves incising the perineal body skin and
the sphincter muscles and a posterior sagittal incision to the coccyx. Perineal body
dehiscence is the most common and morbid complication post-PSARP which can have a
negative impact on future bowel control. With consideration of all the other approaches
described to repair this anomaly, we developed a perineal body sparing modification
of the standard PSARP technique.
Methods Four patients with ARM with a rectovestibular fistula were repaired with a perineal
body sparing modified PSARP at a single institution between 2020 and 2021. The incision
used was limited, involving only the length of the anal sphincter, with no incision
anterior or posterior to the planned anoplasty. Dissection of the distal rectum and
fistula was performed without cutting the perineal body. Once the distal rectum was
mobilized off the posterior vaginal wall and out of the vestibule, the perineal body
muscles, where the fistula had been, were reinforced and an anoplasty was then performed.
Results Operative time was the same as for a standard PSARP. There were no intraoperative
or postoperative complications. No postoperative dilations were performed. All patients
healed well with an excellent cosmetic result. All are too young to assess for bowel
control.
Conclusion We present a new technique, a modification of the traditional PSARP for rectovestibular
fistula, which spares the perineal body. This approach could eliminate the potential
complication of perineal body dehiscence.
Keywords
anorectal malformation - posterior sagittal anorectoplasty - rectovestibular
