Imperforate Anus without Fistula
Imperforate Anus
without Fistula in a Male
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About five percent of our entire series included patients with imperforate anus but without a fistula.
In both males and females the rectum lay about two centimeters from the perineal skin.
Most of these patients had a very good sacrum and good muscles.
The defect seems to be equivalent to the rectourethral bulbar fistula in the male or rectovestibular fistula in the female in terms of quality of muscles and sacrum; therefore, those patients have a good prognosis.
The image to the right shows the general characteristics of an imperforate anus without a fistula. Remember that despite the fact that there is no fistula, rectum and urethra share a common wall and have intimate contact. The rectum is usually very ectatic and therefore more likely to require tapering.
The repair of this defect, called Posterior Sagittal Anorectoplasty / PSARP, does not differ from the one described for the rectourethral bulbar and prostatic fistula.
The posterior incision of the rectum must continue all the way down to the most dependent portion of the rectum and then we still are obligated to carry on with a submucosal dissection to separate the rectum from the urinary tract. The rest of the procedure is exactly as the one previously described.
