Positioning the Patient During Posterior Sagittal Anoplasty / PSARP
The operation Posterior Sagittal Anoplasty / PSARP is done under general anesthesia with endotracheal intubation.
The patient is placed in a prone position with the pelvis elevated and special care must be taken to guarantee that the baby is well ventilated.
For this, two small bolsters must be used in front of the deltopectoral groove on each side to avoid severe hyperextension of the neck.
We like to fix the legs to the table with adhesive tape to be sure the patient does not move if the surgeon requires tilting the table to the Trendelenburg or lateral position.
A Foley catheter must be inserted in the bladder prior to the positioning of the patient. At the time of catheter placement, usually about 25 percent of the time the catheter passes via the fistula no matter how hard the surgeon attempts to enter the bladder.
If this is the case, the author's recommendation is to leave the tube in the rectum and go ahead with the operation. The catheter will then be repositioned into the posterior urethra under direct vision once the defect has been exposed.
The electrical stimulation of the perineum allows the surgeon to identify the anal dimple, where he will be able to detect two types of contractions:
- Due to the action of the parasagittal fibers, tends to close the new anus
- Consists in the elevation of the anal dimple skin, is provoked by contraction of the vertical fibers (muscle complex)
Most patients with a rectourethral bulbar fistula have a "good-looking perineum," and therefore, a very active perineal muscle contraction. These patients require a full posterior sagittal operation.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
