From the Research
Surgical Steps for Posterior Sagittal Anorectoplasty (PSARP)
The surgical steps for PSARP involve:
- A median sagittal incision that runs from the sacrum to the anal dimple, cutting through all muscle structures behind the rectum by dividing the levator muscle and the muscle complex 1
- Location of the rectum in front of the levator and within the limits of the muscle complex 1
- Dissection of the distal rectum and fistula without cutting the perineal body, in some modified techniques 2
- Tapering of the rectum to allow suturing of the muscle behind it, as the rectum is generally ectatic and cannot be pulled through without destroying the muscle structures present 3
- Separation of the rectum and urethra (or vagina) which are closely joined and share a common wall, requiring extensive exposure 3
- Placement of the rectum within the limits of the sphincteric mechanism, to determine the limits of the sphincteric mechanism and to place the rectum within its limits 4
Modified Techniques
Some modified techniques of PSARP include:
- Muscle Complex Saving-Posterior Sagittal Anorectoplasty (MCS-PSARP), which keeps the funnel-shaped muscle complex completely intact and does not divide it, and pulls the rectum through this funnel, toward fixing the new anus to the skin 1
- Perineal body sparing modification of the standard PSARP technique, which involves a limited incision and dissection of the distal rectum and fistula without cutting the perineal body 2
- Laparoscopic-assisted anorectal pull-through (LAARP), which positions the neorectum accurately inside the sphincter complex without dividing any of these muscles 5