Posterior Sagittal Anorectoplasty for Congenital Rectovaginal Malformations in the Adult

Abstract

Posterior sagittal anorectoplasty is a well accepted procedure utilized for repair of congenital imperforate anus. This procedure allows acceptable function and quality of life in these unfortunate children. However, for obvious reasons it is seldom performed in the adult patient. In this video, we demonstrate a unique case of a congenital imperforate anus in an adult patient who presented initially with fecal incontinence at 42 years of age. Inspection of her perineum revealed the typical appearance of a congenital imperforate anus with rectovestibular fistula. Intraoperative localization of the external sphincter with a Pena nerve/muscle stimulator (Integra, Plainsboro, NJ) revealed its presence in the appropriate posterior midline location. A two-staged procedure is utilized. This begins with a laparoscopic end sigmoid colostomy followed by the anorectoplasty three weeks later. We demonstrate the technique of posterior sagittal anorectoplasty with the patient in the prone jackknife position. Postoperative function one year after colostomy reversal demonstrates good continence with peak manometric resting and squeeze pressures of 26 mm and 42 mm respectively. Though not usually pertinent in the adult setting, posterior sagittal anorectoplasty should be considered an acceptable option for adults with anorectal malformations.