Posterior sagittal anorectoplasty (PSARP). A new approach for treating anorectal malformations.

Abstract

Background:-Anorectal malformation is a congenital anomaly of different varieties and its correction needs good experience , knowledge about this varieties and specific surgical tools,
otherwise the child may lose his the only chance to live normally without disastrous complication like incontinence.
Objective:-assessment of the advantage of this procedure in management of anorectal malformations and the percentage for anal continence.
Patients and methods:-. This study was carried out in the child's central teaching hospital in Baghdad total number (70) cases were included in the study, 37 males and 33 females: aged 7 days to 6 years. They attended the hospital between October 1998-october 2004.
 Male defect included:
1) Low type ....5 cases No colostomy needed.
2) Intermediate type.... 23 cases. needed colostomy
3) High type.... 9 cases needed colostomy.
• Female defects:
1) Imperforate anus with vestibular fistula---31 cases.
2) Imperforate anus without fistula 2 cases.
Results: From the study we gain the following results:- all the male patients with low and intermediate types 28 cases (40%) show 100% continence. All female patients with imperforated anus with vestibular fistula and without fistula 33 cases (47%) show 100% continence. The combination of male and female patients show 61 patients of 70 show 100%continence in a percentage of 87%. The nine cases (12.85%) with recto bladder neck fistula show poor continence due to their bad sacral contour associated with the poor development of pelvic muscles sphincter. This result was revealed from follow-up together with the presence of external sphincter muscle contraction which occurs during digital PR examination or by the use of surgical dilators.
Conclusion: From the study we found that this procedure gives high percentage of continence and should be used instead of other procedures.