Minimal Posterior Sagittal Anoplasty / MPSARP for Females
Colorectal Center specialists at Cincinnati Children's Hospital Medical Center provides information about Minimal Posterior Sagittal Anoplasty / MPSARP for females.
Traction Sutures
Anoplasty
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Repair Completed
Rectum Anchoring
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The patient is placed in the prone position, with the pelvis elevated as previously described. Multiple 6-0 silk stitches are placed at the mucocutaneous junction of the fistula, which will be used to exert uniform traction.
A small incision is made, and the external sphincter is cut exactly in the middle with the needle tip cautery.
The electrical stimulator is used to check that the muscle contraction is equal in intensity and symmetric on both sides of the midline.
The incision will continue in a "racket-like" fashion around the fistula.
The dissection between rectum and vagina is easy because there is a natural plane of dissection and therefore, no risk of injuring the vagina.
The dissection must proceed high enough so that the rectum lays comfortably in its proper location allowing the rectoperineal anastomosis to be performed within the boundaries of the external sphincter without tension.
Once the rectum has been mobilized enough, the perineal body is reconstructed with long-term fine absorbable sutures and the posterior edge of the muscle complex is also sutured, anchoring it to the rectal wall as seen previously.
The anoplasty is then performed in the same way as previously described. The prognosis is excellent, and the only sequellae that we have observed in these patients are varying degrees of constipation which are readily alleviated by medical management.
However, constipation must not be underestimated, since when left untreated it progresses creating a chronic fecal impaction that results into overflow pseudoincontinence.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
