What are the steps involved in a posterior sagittal anorectoplasty (PSARP) procedure?

From the Research

The steps involved in a posterior sagittal anorectoplasty (PSARP) procedure include a midline incision from the sacrum to the perineum, division of the parasagittal fibers and sphincter complex, identification and mobilization of the rectum, ligation of any fistulous connections, reconstruction of the sphincter muscles, and creation of a properly sized and positioned anal opening. The procedure begins with the patient placed in a prone position with the pelvis elevated, followed by sterile preparation and a midline incision. The surgeon then divides the parasagittal fibers and sphincter complex precisely in the midline, taking care to preserve the nerve supply, as described in the study by 1.

Key Steps in PSARP Procedure

• The patient is placed in a prone position with the pelvis elevated
• A midline incision is made from the sacrum to the perineum
• The parasagittal fibers and sphincter complex are divided precisely in the midline
• The rectum is identified and mobilized from surrounding structures
• Any fistulous connections to the urinary tract or genital system are identified and ligated
• The rectum is placed within the center of the sphincter complex, ensuring proper positioning
• The sphincter muscles are meticulously reconstructed around the rectum using absorbable sutures
• The anoplasty is completed by suturing the rectal mucosa to the skin to create a properly sized and positioned anal opening

The most recent and highest quality study, 2, describes a modification of the traditional PSARP technique that spares the perineal body, which could potentially eliminate the complication of perineal body dehiscence. This study highlights the importance of preserving the perineal body and sphincter muscles to achieve optimal outcomes in terms of bowel control and quality of life.

Postoperative Care

• Anal dilatations are typically started 2-3 weeks after surgery and continued on a decreasing schedule for several months to prevent anal stenosis
• The patient is closely monitored for any signs of complications, such as infection or breakdown of the repair
• Follow-up appointments are scheduled to assess the patient's progress and adjust the treatment plan as needed, as described in the study by 3.

Overall, the PSARP procedure is a complex and delicate operation that requires careful attention to detail and a thorough understanding of the anatomy and physiology of the anorectal region. By following the steps outlined above and using the most recent and highest quality evidence, surgeons can achieve optimal outcomes for their patients and improve their quality of life.