From the Research
Posterior sagittal anorectoplasty (PSARP) is a more comprehensive procedure compared to posterior sagittal anoplasty (PSAP), and is generally preferred for higher and more complex anorectal malformations. The main difference between the two procedures lies in the extent of the dissection and the complexity of the malformation being corrected. PSARP involves a midline incision from the sacrum to the anal site, division of the external sphincter complex, identification and repair of any rectourinary or rectovaginal fistula, mobilization of the rectum, and reconstruction of the sphincter complex around the newly positioned rectum 1. On the other hand, PSAP is typically used for less complex malformations like perineal fistulas or minor anal stenosis, involving a more limited dissection. The choice between these procedures depends on the specific type and severity of the anorectal malformation, with preoperative assessment including physical examination and imaging studies being crucial for surgical planning 2. Some studies have suggested modifications to the original PSARP technique to minimize the risk of complications and the length of hospital stay, particularly in areas with limited medical resources 3. However, the most recent and highest quality study on the topic, published in 2024, highlights the importance of preserving the anterior wall of the fistula without leaving an anterior or a posterior sagittal incision, and reports good results with a shorter surgical time and hospital stay 1. Key points to consider when choosing between PSARP and PSAP include:
- The type and severity of the anorectal malformation
- The extent of the dissection required
- The potential for complications and the need for long-term follow-up
- The availability of medical resources and the expertise of the surgical team. Overall, PSARP is the preferred procedure for higher and more complex anorectal malformations, due to its ability to provide complete exposure of the rectal pouch, fistula, and surrounding structures, and to allow for reconstruction of the sphincter complex around the newly positioned rectum 1.