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Abstract
The development of the posterior sagittal anorectoplasty approach has been a major
recent advance in the repair of imperforate anus. It has been found that sagittal
anoplasty can easily and preferably be carried out in the newborn period without the
need for colostomy or “tapering”. It is suggested that the perineal sagittal approach
be attempted first, with the infant positioned so that the abdominal part of the abdominoperineal
approach can be used if necessary—this seldom may be required. Neonatal closure of
urinary tract fistulas in boys is an added attractive feature of this approach. The
importance of optical magnification (microsurgery) and excellent, intense lighting
of the perineal area with a headlamp is stressed for this approach in the newborn,
particularly for the management of high pouches and high fistulas. This operation
at birth relieves alimentary tract obstruction at birth, eliminates urinary tract
contamination (when it exists) at birth, establishes anorectal continuity and maximum
potential for “normal” defecation reflexes at birth, and achieves all of this in one
rather than three operations.
Keywords
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References
- Posterior sagittal anorectoplasty: Important technical considerations and new applications.J Pediatr Surg. 1982; 17: 796-811
- Anorectal Malformations in Children.Year Book Medical, Chicago, IL1971
- Congenital malformations of the rectum and anus: I. Clinical features and management in 120 cases.Surgery. 1952; 32: 352-366
- Congenital malformations of the rectum and anus: II. Associated anomalies encountered in a series of 120 cases.Surg Gynecol Obstet. 1952; 95: 281-288
- A simultaneous abdominal and perineal approach in operations for imperforate anus with atresia of the rectum and rectosigmoid.Ann Surg. 1948; 127: 552-556
- Lambrect W Lierse W The internal sphincter in anorectal malformations: Morphologic investigations in neonatal pigs. ed 2. J Pediatr Surg. 22. 1987: 1167 (discussion)
Article info
Publication history
Accepted:
August 2,
1989
Identification
Copyright
© 1990 Published by Elsevier Inc.
