Opening the Rectum During Posterior Sagittal Anoplasty / PSARP
Colorectal Center surgeons at Cincinnati Children's Hospital Medical Center provides information about the opening of the rectum in Posterior Sagittal Anoplasty / PSARP.
Trying to go around the rectum, as was done in the past, is never recommended because there is a high chance of injuring the urinary tract, vas deferens, prostate and seminal vesicles.
Two 5-0 silk stitches are placed in both sides of the midline, taking full-thickness rectal wall and making a posterior incision to see inside the rectum.
As the incision in the posterior rectal wall is continued, we keep placing 5-0 silk sutures in both bowel edges so as to keep the incision open to immobilize the field and see inside the rectum.
These same sutures eventually will help to put traction on the rectum at a later stage when we try to gain bowel length.
Figure One
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Figure Two
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Figure Three
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Figure two illustrates the rectum open in a case of rectourethral bulbar fistula, and the fistula site can be seen at its lowest portion. Immediately above the fistula, a series of folds is seen which is indistinguishable from the pectinate line of a normal individual.
Figure three shows a case of a rectourethral prostatic fistula, where the rectum lies at a higher position.
Therefore, the midline skin incision could possibly stop at the level of the external sphincter, and may not have to be prolonged anteriorly as is done for a bulbar fistula in order to deal with the fistula site in a more comfortable way.
On the other hand, in a prostatic type of fistula, the amount of dissection that the rectum will require in order to gain enough length and achieve a rectal-perineal suture is much greater than in a case of a bulbar fistula.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
