Minimal Posterior Sagittal Anoplasty / MPSARP for Perineal Fistulas in Males
It is important to place a
Foley catheter in the bladder before the operation is started. The surgeon must keep in mind that even when there is no rectourethral fistula, the rectum and urethra lie very close together.
The patient is placed in the prone position with the pelvis elevated.
A protective colostomy is not necessary in these cases. The incision is small and starts a little posterior to the external sphincter, passes through the center of the external sphincter and around the fistula.
Multiple 6-0 silk sutures are placed, taking the mucocutaneous junction of the fistula; these stitches will allow the surgeon to exert a uniform traction, thus allowing meticulous dissection of the rectum.
The dissection is carried out carefully, particularly in the anterior aspect of the rectum to prevent urethral damage.
The electrical stimulator proved to be very effective and helpful in identifying all striated muscle structures and preserving them intact.
The plane of dissection must be created between the striated muscle structures and the bowel wall, keeping them intact.
The dissection must continue high enough, mobilizing the bowel sufficiently to achieve a good, comfortable, anastomosis to the skin within the limits of the external sphincter. The technique is very similar to the one used in the cutaneous / perineal fistula seen in females.
Once the bowel has been mobilized enough, it is necessary to suture together both anterior edges of the muscle complex as well as the posterior edges; then, the perineal body is reconstructed and the anoplasty must be done with 16 stitches of 6-0 long-term absorbable sutures. The incision is then closed posteriorly with interrupted 5-0 stitches.
The final photo on the right shows the perineum at the end of the procedure, which can be done in the newborn period, provided the surgeon feel experienced enough with this type of procedure.
For more information or to request an appointment, please contact the Colorectal Center at Cincinnati Children's.
