Internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations ? technical considerations

Abstract

Posterior sagittal anorectoplasty (PSARP) has gained overall acceptance as a standard surgical approach for the repair of high and intermediate anorectal malformations. PSARP allows superior exposure for the identification of the spectrum of these defects and enables anatomic reconstruction of the anal canal and voluntary sphincter muscle complex. In the original PSARP procedure, the involuntary internal anal sphincter, which in embryologic and clinical studies has been shown to be present in the region of the fistulous bowel termination, is not preserved. Internal sphincter-saving PSARP was performed in 65 patients with high or intermediate anorectal malformations. Manometrically, a positive rectoanal inhibitory reflex was noted in 82% of the patients, suggesting the presence of a functional internal sphincter. There was a statistically significant difference in the anorectal resting pressures between patients with a functional internal sphincter and patients without this structure. The technical details of internal sphincter-saving PSARP are described and illustrated in the present communication.