Abstract
The posterior sagittal transsphincteric approach is useful for surgical management of tumors, fistulae, and sequelae of failed pull-throughs for congenital anomalies, particularly when these conditions are located too high to be approached conveniently through the perineum or too low to be approached through the abdomen. Except for anorectal malformations, there have been no previous reports of use of this approach in children. Five cases are presented to demonstrate the advantages of this approach: two patients with severe sequelae of pelvic trauma; one with a large tumor invading the rectum and vagina; one case of adrenal hyperplasia, urogenital sinus, and a high implanted vagina; and one case of a failed pull-through for the treatment of Hirschsprung's disease. All patients are continent of stool and urine. The authors suggest using this approach with a protective colostomy.
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