Incision During Posterior Sagittal Anorectovagino-Urethroplasty / PSARVUP
Cloaca Incision
CL Rectum Opening
Open Closac
|
Colorectal Center surgeons at Cincinnati Children's Hospital Medical Center provide information about the incision made during
Posterior Sagittal Anorectovagino-Urethroplasty / PSARVUP.
The incision starts from the middle portion of the sacrum, passing through the center of the external sphincter, and ending at the single orifice that the patient has in the perineum.
The skin is divided with a needle-tip cautery, then the subcutaneous tissue, parasagittal fibers, and the vertical fibers (muscle complex) are divided.
The incision is then continued deeply to meet the levator muscle which is opened exactly in the midline.
Once the levator has been opened, a visceral structure is visible. The most frequent organ to be found is the rectum, which must be opened exactly in the midline to see the characteristics of the cloaca.
However, care must be taken because it is not unusual to find all kinds of bizarre arrangements of the different visceral structures.
On rare occasions, the vagina is located posterior to the rectum and the rectum opens between the vagina and the urinary tract.
At other times, when the patient has a high rectal opening, the visceral structure that is seen is the vagina; to find the rectum, the operator must look up into the vaginal dome.
In the most typical type of cloaca, once the rectum has been opened, the vaginal opening and the urethral opening become evident.
At this point, the surgeon has the opportunity to measure directly the length of the common channel which has important, therapeutic technical implictions as will be seen later.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
