Sphincter‐saving anorectoplasty for correction of anorectal malformations

Abstract

AimPosterior sagittal anorectoplasty (PSARP) popularized by de Vries and Peña has become the preferred technique for surgical correction of anorectal malformations (ARM). Despite performing a technically perfect operation, it involves midline division of the sphincter with a subset of patients requiring significant lifelong bowel management for constipation or incontinence. Pratap et al. introduced sphincter‐saving anorectoplasty (SSARP) trying to spare the sphincter. The aim of this study is to preserve the neurophysiological function of the sphincter through SSARP in ARM patients and evaluate the outcome of these patients through this approach.Patients and MethodsThis prospective study conducted on ARM cases presented with high or intermediate anomalies. Patients with sacral agenesis and rectovesical fistula were excluded from the study. All patients underwent pre and postoperative electrophysiological studies of the external anal sphincter. Also a guide wire was introduced through the middle of the sphincter under sonographic guidance in all patients immediately before the operation.ResultsDuring the study period from January 2011 to September 2014 18 cases underwent surgical correction with SSARP technique. Their age ranged from 6 months to 5 years and weight ranged from 7 kg to 20 kg. The total duration of the SSARP procedure ranged from 65 to 90 min. There were no intra‐operative complications or mortality. No conversion to classic PSARP approach was necessary in any case. During the follow‐up period no recurrent urethral fistula or urinary retention was observed.ConclusionSSARP technique is a safe and effective approach in correction of ARM with acceptable postoperative complications.