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Eur J Pediatr Surg 2023; 33(06): 463-468
DOI: 10.1055/a-1976-3611
Original Article

Sparing the Perineal Body: A Modification of the Posterior Sagittal Anorectoplasty for Anorectal Malformations with Rectovestibular Fistulae

Andrea Badillo
1   Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
,
Laura Tiusaba
1   Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
,
Shimon Eric Jacobs 
1   Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
,
Tamador Al-Shamaileh
2   Department of General Surgery, Faculty of Medicine, Mutah University, Karak, Jordan
,
Christina Feng
1   Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
,
Teresa Lynn Russell 
1   Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
,
Elizaveta Bokova
1   Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
,
Anthony Sandler
1   Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
,
Marc A. Levitt
1   Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, District of Columbia, United States
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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


Publication History

Received: 25 May 2022

Accepted: 07 November 2022

Accepted Manuscript online:
10 November 2022

Article published online:
29 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Response to: Sparing the Perineal Body, A Modification of the Posterior Sagittal Anorectoplasty (PSARP) for Anorectal Malformations with Rectovestibular FistulaeEur J Pediatr Surg 2023; 33(04): 329-329
DOI: 10.1055/s-0043-1770998

Comment to this article:

Sparing the Perineal Body in the Vestibular FistulaEur J Pediatr Surg 2023; 33(04): 328-328
DOI: 10.1055/s-0043-1770997

 

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