Health Library

Pull-Through (PSARP) Surgery

What Is a PSARP? 

A posterior sagital anorectoplasty (PSARP), sometimes called a pull-through surgery, is a procedure that repairs anorectal malformations, or defects of the rectum and/or anus. Children can be born with many kinds of malformations. Your child’s doctor will do an exam on your child and review a series of test to figure out the type of defect. Then they will discuss the best treatment plan for your child. This will often include surgery.

Before Surgery

• Children with some types of malformation need to go to the hospital the day before surgery for bowel prep.
• If your child does not need to go to the hospital the day before surgery, the nurse will call you 48 hours (2 days) before the surgery date. They will discuss:
• Rules about eating and drinking
• When you need to arrive at the hospital
• Talk with the doctor if your child takes any medicine. Do not give your child any medicine on the morning of surgery unless your child’s doctor tells you to.
• On the day of surgery, the health care team will make sure your child is ready for surgery.

After Surgery

• Your child will be in the hospital for several days after surgery.
• They will likely have mild pain from the incision. A plan will be made to help with their comfort.
• Your child may have a special tube to drain urine (pee) from the bladder for a few days after surgery.
• We will teach you how to care for your child’s incision.

Two (2) to four (4) weeks after surgery, anal dilations will be started. This will keep the anus from getting narrow as it heals. Here are some things you need to know about this:

• A dilator (medical rod) is used to help keep your child’s new anus from getting narrow.
• It is crucial for the family to follow the plan given to them.
• The surgeon will do the first dilator.
• The surgeon or nurse will teach you how to do the dilations. You will do these once in the morning and once in the evening.
• They are done two times each day – one time in the morning and one time in the evening, but make sure you follow the dilation plan given to you.
• If the dilation plan is not done right, your child may need more surgery

If your child has a colostomy, it can be closed by surgery about 8-12 weeks after PSARP.

When to Call the Doctor

Call your child’s doctor at the Colorectal Center if you notice: 

• Bleeding from your child’s incision or area of the surgery.
• Fever (temperature over 100.4° F).
• There is no stool (poop) in the colostomy bag or your child has not pooped in their diaper for more than 24 hours (1 day).
• Your child has not peed in their diaper or the toilet at least one time every 4-6 hours.

Call the Colorectal Center at 513-636-3240 if you notice any of these issues or if you have any questions or concerns.