Reconstruction
The staff of the Colorectal Center at Cincinnati Children's Hospital Medical Center provides information about reconstruction in Posterior Sagittal Anoplasty (PSARP).
In cases where the incision extends beyond the limits of the sphincter, it is necessary to repair the anterior perineum with interrupted 5-0 long-term absorbable sutures; the sutures must barely include the anterior edge of the muscle complex.
Once the perineum has been repaired, a series of 5-0 sutures is placed in the levator edge. The reason for placing the sutures before passing the rectum in front of the levator is to better visualize the limits of the levator muscle. If the surgeon first places the rectum and then tries to find the levator edge, there may be difficulty identifying it. The electrical stimulator is always helpful in identifying all these muscle structures.
The rectum is then passed in front of the levator, to be located immediately behind the urethra. The levator sutures are then tied, and the surgeon continues suturing the posterior edge of the muscle complex. These sutures must include a portion of the posterior aspect of the rectum. The rest of the layers of the incision are reapproximated with interrupted 5-0 long-term absorbable sutures.
