Tapering the Rectum
Colorectal Center surgeons at Cincinnati Children's Hospital Medical Center provides information about tapering the rectum in Posterior Sagittal Anoplasty / PSARP.
Illustration of a
nondiverting colostomy. |
At this point, we must remember that the final goal is to relocate the rectum in front of the levator muscle, immediately behind the urethra, within the limits of the muscle complex and the external sphincter.
Sometimes, the rectum is very distended and ectatic, making it physically impossible to achieve our goal.
In such cases, tailoring (tapering) of the rectum seems to be imperative in order to accommodate the rectum within the limits of the muscle structures.
This is a decision that must be made at the time of the operation. Again, the size of the rectum varies from one patient to another and may bear some relationship to the type of colostomy that was originally used.
Occasionally, a nondiverting colostomy may produce a very ectatic rectum, therefore, the amount of rectum resected varies from one patient to another.
The tapering is achieved by resecting part of the posterior rectal wall. The seromuscular defect created in the anterior rectal wall due to the submucosal dissection can be repaired with interrupted stitches.
The mobilization of the rectum must be a sufficient to guarantee leaving a normal rectal wall in front of the urethral sutures.
We do not think that the tapering should ever be done in the anterior aspect of the rectum because this will leave a rectal suture in contact with the urethral suture, predisposing to the formation of a new fistula.
The images below show the process of tapering of the rectum. The rectum sutures must be done in an interrupted fashion in two layers, using long-term absorbable sutures.
The process of tapering of the rectum. |
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
