Sagittal Approach Research Articles

A novel simplified sonographic approach with fluoroscopy-controlled L5 transforaminal epidural injections in patients with high iliac crest: a retrospective study

BackgroundTo explore a novel ultrasound (US) modality for lumbar transforaminal epidural injections (TFEIs) in patients with low back pain (LBP) and L5 radicular pain combined with high iliac crest (HIC).MethodsOne-hundred and forty-one patients were retrospectively stratified into two groups based on the treatment they received: novel group, receiving US-guided and fluoroscopy (FL)-controlled TFEIs using a sagittal oblique approach between the superior articular process of L5 and S1, and control group, receiving US-guided TFEIs with conventional transverse approach combined with FL confirmation. Accuracy of contrast dispersing into lumbar epidural space was set as the primary endpoint. Radiation dosages, procedure time, numeric rating scale (NRS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, adverse events, and rescue analgesic requirement were also recorded. The generalized liner mixed model (GLMMs) was employed to compare the repeatedly measured variables between groups, taking individual confounding factors as covariance.ResultsThe accuracy of TFEIs was 92.8% and 65.2% in novel and control group, with a significant difference of 26.7% (95% CI: 15.4%, 39.8%) between two modalities (p < 0.001). Significant pain relief was observed in novel group as opposed to control group after one injection. Procedure time in novel group (8.4 ± 1.6 min) was shorter than control group (15.8 ± 3.5 min) (p < 0.001) with less radiation dosage (3047 ± 5670 vs. 8808 ± 1039 μGy/m2, p < 0.001). Significantly, lower incidence of L5 paresthesia occurred in novel group. Statistical differences of NRS scores between the novel and control group were reached at 1 week after procedure (1 (IQR: − 1–3) vs. 3 (IQR: − 1–7), p = 0.006), while not reached at both 1- (1 (IQR: 0–2) vs. 1 (IQR: − 1–3), p = 0.086) or 3-month follow-up (0 (IQR: − 1–1) vs. 1 (IQR: 0–2), p = 0.094). Both groups showed similar functional improvement (F = 0.103, p = 0.749) during follow-up.ConclusionsThe novel sonographic technique provided superior accuracy needle placement and better pain-relieving effect through one injection as compared to the routine transverse approach. Consequently, in situations where the HIC imposed limitations for TFEIs performance on L5, the novel technique should be recommended to consider increasing accurate puncture, minimizing radiation exposure, consuming procedure time, and reducing the risk of neuraxial injury.

Endovascular stenting using a sagittal sinus approach for sigmoid sinus wall dehiscence related to intractable pulsatile tinnitus: a case series

BackgroundSigmoid sinus wall dehiscence can lead to pulsatile tinnitus with a significant decrease in quality of life, occasionally leading to psychiatric disorders. Several surgical and endovascular procedures have been described for resolving dehiscence. Within endovascular procedures, the sagittal sinus approach could be a technical alternative for tracking and accurate stent positioning within the sigmoid sinus when the jugular bulb anatomy is unfavorable.Case presentationA retrospective case series of three patients with pulsatile tinnitus due to sigmoid sinus wall dehiscence without intracranial hypertension was reviewed from January 2018 to January 2022. From the participants enrolled, the median age was 50.3 years (range 43–63), with 67% self-identifying as female and 33% as male. They self-identified as Hispanic. Sigmoid sinus dehiscence was diagnosed using angiotomography, and contralateral transverse sinus stenosis was observed in all patients. Patients underwent surgery via a navigated endovascular sagittal sinus approach for sigmoid sinus stenting. No neurological complications were associated with the procedure. Pulsatile tinnitus improved after the procedure in all patients.ConclusionsSuperior sagittal sinus resection for sigmoid sinus wall stenting is a safe and effective technique. Pulsatile tinnitus due to sigmoid sinus wall dehiscence could be treated using the endovascular resurfacing stenting technique. However, further research is needed to evaluate the potential benefit of contralateral stenting for removing sinus dehiscence when venous stenosis is detected. However, resurfacing sigmoid sinus wall dehiscence results in symptomatic improvement.

Transoral Robotic-Assisted Neurosurgery for Skull Base and Upper Spine Lesions.

The application of the da Vinci Surgical System in neurosurgery is limited due to technical difficulties requiring precise maneuvers and small instruments. This study details the advantages and disadvantages of robotics in neurosurgery and the reachable range of the transoral approach to lesions of the skull base and upper cervical spine. In a cadaver study, the da Vinci Xi robot, lacking haptic feedback, was utilized for sagittal and coronal approaches on 5 heads, facilitating dura suturing in 3, with a 30°-angled drill for bone removal. Perfect exposure of all the nasopharyngeal sites, clivus, sellar, and choana, including the bilateral eustachian tubes, was achieved without any external incisions using this palatal split approach of transoral robotic surgery. The time required to perform a single stitch, knot, and complete single suture in robotic suturing of deep-seated were significantly less compared to manual suturing via the endonasal approach. This is the first report to show the feasibility of suturing the dural defect in deep-seated lesions transorally and revealed that the limit of reach in the coronal plane via a transoral approach with incision of the soft palate is the foramen ovale. This preclinical investigation also showed that the transoral robotic approach is feasible for lesions extending from the sellar to the C2 in the sagittal plane. Refinement of robotic instruments for specific anatomic sites and future neurosurgical studies are needed to further demonstrate the feasibility and effectiveness of this system in treating benign and malignant skull base lesions.

Sacrococcygeal teratoma: an experience from a high-volume tertiary institute in North India

Background: Sacrococcygeal teratoma (SCT) is the most common tumour in the newborn. The majority is present in neonates as a sacral mass; however, some may be present late with varied clinical presentation. The study aims to evaluate the clinical presentation and management of patients with SCT in our high-volume tertiary institute in North India. Methods: This is an observational study of infants and children treated between May 2021 to April 2022 in the department of pediatric surgery, SMS Medical College, Jaipur (a high-volume tertiary institute in North India). Data collected included antenatal diagnosis, mode of delivery, age at diagnosis, clinical presentation, Altman classification, surgical approach, histopathology and complications. Functional results were evaluated clinically and radiologically. Results: Twenty-one patients (M: F=1:3.2) with a median age of 40 days (range: 1 day to 5.8 years) with SCT were managed at our centre. Nearly, two-thirds of the tumors were either Altman type 1 or 2. Yolk sac tumour was present in 2 (9.5%) patients, while the rest had either mature or immature teratoma. Tumours were removed through a posterior sagittal approach (chevron incision). In five patients, an abdominoperineal approach was used. Early complications were surgical site infection (n=5; 23.8%), superficial wound dehiscence (n=2; 9.5%), complete wound dehiscence (n=1; 2.4%), and urinary tract infection (n=1; 4.7%). Late complications were urinary dribbling or poor stream (5/21; 23.8%) and faecal soiling (n=3; 14.2%). Conclusions: Most of the sacrococcygeal tumours are benign, and the incidence of malignancy increases with age. Morbidity due to associated malformation and treatment may persist in these patients, especially like urinary complications stream (one-fifth) and faecal incontinence (one-seventh), as seen in our series. A proper long-term follow-up is needed for the management of late complications.

Redo Surgeries in Anorectal Malformations: A Single-center Experience.

Complications following posterior sagittal anorectoplasty (PSARP) for ARM are well known. In this article, we present our experience of managing five patients who required major redo surgeries for complications resulting from previous attempts to correct ARM. We reviewed all patients who underwent major redo surgeries in our hospital for complications from previous repairs for ARM, from June 2013 to June 2019. Data was obtained from hospital records and analysed. Five patients whose ages ranged from 5 months to 14 years were included in the study. Four were boys and 1 was a girl. All patients had undergone PSARP in other hospitals. The presentations were retained distal bowel causing urinary retention and constipation (n=1), pulled through proximal urethra and bladder neck presenting as passage of urine from neo-anus (n=1), retained common channel (of cloaca) causing a 'H' type configuration (n=1), mispositioned neo-anus (n=1) following a primary PSARP and lastly undivided recto-urethral fistula causing fecaluria (n=1). All of them underwent redo repairs by posterior sagittal approach with documented improvement in their symptoms. Two of them required total bowel management to remain clean. All the complications reported here have been described in literature nevertheless, this report will add to the body of experience. Posterior sagittal approach (PSA) has proved to be very successful technique in correcting these complications.

Postoperative complications in males with anorectal malformations depending on the surgical approach

BACKGROUND: Anorectal abnormalities occur in 1:1,500 to 1:5,000 live births. There is still no agreement on the best surgical procedure for treating some types of anorectal abnormalities in males. Anorectoplasty could be performed using the posterior sagittal approach and using laparoscopic techniques.&#x0D; AIM: To assess the risk of postoperative complications and determine their specificity in males with anorectal malformations, depending on the surgery approach.&#x0D; MATERIALS AND METHODS: A single-center retrospective cohort study was performed. Male patients with anorectal malformations who had surgical correction of anorectal malformation by posterior sagittal (group I) or laparoscopic-assisted anorectoplasty (group II) at the age of up to 1 yr at the N.F. Filatov Childrens City Clinical Hospital from 2008 to 2022. Postoperative and intraoperative problems and the number of surgical interventions that had to be redone to correct issues were noted.&#x0D; RESULTS: Of the 33 patients in group I, 18 (55%) had anorectal malformations with bulbar fistula, 12 (36%) had anorectal malformations without fistula, and three (9%) had a prostatic fistula. Group II included 99 patients, with 53 (54%) having anorectal malformations with prostatic fistula, 30 (30%) having anorectal malformations with bulbar fistula, nine (9%) having anorectal malformations with bladder neck fistula, and seven (7%) having anorectal malformations without a fistula. The incidence of intraoperative and postoperative complications was statistically significantly higher in children after posterior sagittal anorectoplasty than laparoscopic-assisted anorectoplasty: I, 19 (58%) versus II, 33 (33%); p = 0.014. The number of redo surgical interventions to correct complications did not differ significantly between the studied groups: I, 8 (24%) versus II, 26 (26%); p = 0.819. The incidence of urethral damage was identified with posterior sagittal anorectoplasty compared with laparoscopic-assisted anorectoplasty: I, 4 (12%) versus II, 0 (0%); p 0.001. We found no differences in postoperative complications between laparoscopic-assisted and posterior sagittal anorectoplasty.&#x0D; CONCLUSIONS: The results define laparoscopic-assisted anorectoplasty as a viable and promising method that does not have specific postoperative complications if it is technically correctly performed. It is necessary to develop clear criteria for rectum mobilization and the volume of rectourethral fistula dissection during laparoscopic-assisted surgery to reduce the risks of postoperative problems and repeat surgery.

Posterior Sagittal Approach Provides Optimal Exposure for Urethral Reconstruction in Children With a History of Anorectal Malformations

ObjectiveTo present a unique series of children with previously repaired anorectal malformations (ARM) with subsequent urethral pathology repaired via a posterior sagittal exposure and highlight the associated technical advantages. MethodsUsing a retrospective review of all procedures performed in our pediatric colorectal and pelvic reconstruction program from January 2020 through December 2022, we compiled a case series of patients with a history of ARM and prior PSARP who had urethral pathology and concurrent indication for redo-PSARP. Clinical features, operative details, and postoperative outcomes were collected. ResultsSix male patients presented at a median age of 4.3 years, all born with an ARM of recto-urinary fistula type, of which three were recto-prostatic, one recto-bladder-neck, and two unknown type. In addition to redo-PSARP, two underwent ROOF excision and four had urethral stricture repair. One required post-operative Heineke-Mikulicz anoplasty. Patients underwent cystoscopy 4-6 weeks post-reconstruction, and none showed urethral stricture requiring treatment. Post-procedurally, five patients were able to void urethrally and one required additional bladder augmentation / Mitrofanoff. ConclusionRedo-PSARP completely mobilizes the rectum, thereby providing excellent exposure to the posterior urethra for repair. This approach also allows the option of a rectal flap for augmented urethroplasty as well as harvest of an ischiorectal fat pad for interposition.

Treatment of complications after surgery for Hirschsprung’s disease using posterior sagittal transanal approach (clinical observation)

The experience of complications treatment after surgery for Hirschsprung’s disease using posterior sagittal transanal approach is presented. It allows to obtain a sufficient overview of the main anatomical structures of the small pelvis in a “frozen pelvis” situation, helping to avoid their damage at the scar tissue changes.

Treatment of complications after surgery for Hirschsprung's disease using posterior sagittal transanal approach (clinical observation)

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MRI Diagnosis of Patients Presenting with Low Back Pain

Background: The spine acts as a protective mechanism and houses and guards the vital and fragile spinal cord. MRI has the advantages of nonionizing radiation and excellent visual skills, especially for soft tissues.&#x0D; Objective: To utilize MRI to diagnose lumbar spine sufferers and determine what's causing their low back discomfort.&#x0D; Material and methodology: The study was a cross-sectional one conducted in a Sialkot, Pakistan, private hospital. A sample size of 83 was considered, and the convenient sampling method was used. Data were considered for six months, from October 2022 to March 2023, with informed consent and by the ethical standards outlined by the university's research council. A 0.35T Neusoft MRI scanner was used. Data were analysed using SPSS version 26.&#x0D; Results: In the current study, 69 (83.1%) were male and 14 (16.9%) were female. More men than women are impacted. The best method for identifying the causes of back pain is the sagittal and axial approach. The most effective method is sagittal and axial for confirming low back pain in around 76 (91.6%) individuals. In this study, 76 (91.6%) individuals had bulging discs. The most common patient complaint is lower back pain.&#x0D; Conclusion: An MRI is the most accurate way to diagnose lumbar-vertebral causes of back pain. The sagittal and axial approach is the most effective way to identify the causes of low backache. The most common patient complaint is lower back pain.

Ultrasound-Guided Thoracic Paravertebral Block Using Paraventricular Oblique Sagittal (POS) Approach for the Treatment of Acute Herpes Zoster: A Two-Blind Randomized Controlled Trial.

The aim of this work is to examine the efficacy and benefits of ultrasound (US)-guided thoracic paravertebral block (TPVB) using paraventricular oblique sagittal (POS) approach for the treatment of herpes zoster related acute pain (ZAP) and its preventive effects on post-herpetic neuralgia (PHN). A total of 136 patients suffering from ZAP within 2weeks of rash onset were randomly allocated to transverse short axial approach (TSA) and paraventricular oblique sagittal (POS) group in 1:1 ratio. All patients received a standard antiviral treatment and rescue analgesics besides TPVB. Primary outcome was HZ illness burden (HZ-BOI) measured by a severity-by-duration composite pain assessment during 30days. The non-inferiority margin (NIM) was set at - 10. Secondary outcomes included visual analog pain scores (VAS) and Kolcaba's General Comfort Questionnaire discomfortable scores (GCQ) during block needle insertion, quality of life (QoL), and PHN incidence during follow-up. Adverse events were also recorded. VAS pain scores (30 (IQR: 20, 40) vs. 65 (IQR: 45, 90), p < 0.001) and GCQ discomfortable scores (p < 0.001) were significantly lower in the POS group during needle insertion. The POS approach was not inferior to the proved TSA method in terms of BOI-30AUC when the lower limit of 95% confidence interval (CI) of two mean differences (13.54 (95% CI - 3.55, 30.63)) lay within the NIM. There were no differences between the two groups in BOI-30-90AUC, and BOI-90-180AUC (p = 0.260 and 0.182). Greater QoL improvement and lower PHN incidence were comparable between the two groups. No serious adverse events occurred. US-guided TPVB using less-invasive POS technique was as an optimal early intervention to reduce ZAP and a possible preventive strategy for PHN. The study was retrospectively registered in the Chinese Clinical Trial Registry on November 15, 2022 (ChiCTR2200065783).

VALUE OF PERIODICALLY ROTATED OVERLAPPING PARALLEL LINES WITH ENHANCED RECONSTRUCTION TECHNIQUE COMPARED TO T2 WEIGHTED TURBO SPIN ECHO SEQUENCE ON ROTATOR CUFF INJURIES IN MRI SHOULDER.

Objective: The purpose of the study is to analyze the uses of conventional T2 sequences and PROPELLER technique in view of artifact reduction, increase the image quality and identify signs of pathology on shoulder magnetic resonance imaging. A total number of 36 Materials and Method: patients who underwent shoulder MRI with pain intolerance were included in the study. We used PROPELLER and without PROPELLER technology in the same participants. The MRI scans were evaluated separately by qualied musculoskeletal radiologists. Artifacts, overall image quality, and delineation of several anatomic structures were all investigated in relation to the diagnostic value of an MR arthrography examination. The signicance of propeller was analyzed by implementing Mann Whitney U test. The TSE sequences had worse pulsation artifacts and Results: better overall image quality than PROPELLER sequences. In both Coronal Oblique and Sagittal Oblique approach, delineation of all addressed anatomic structures was much better with PROPELLER sequences than with TSE. The PROPELLER approach for MRI of the Conclusion: shoulder minimizes the frequency of sequences with diagnostic impairment owing to motion artifacts and enhances picture quality when compared to traditional TSE sequences.

A sagittal split osteotomy approach for removal of a large cementoblastoma at the mandibular angle

Benign lesions at the angle of mandible are frequently removed by a conventional intra oral approach to gain access and achieve complete visualisation. This method is quick and effective when dealing with small benign lesions that are superficially located at the angle of mandible. The removal of large and deeply located lesions with a conventional intra oral approach however, bring about a unique set of challenges particularly when the third molar is displaced towards the inferior border of mandible including lack of complete visualisation of the lesion, difficulty in identification and protection of the inferior alveolar nerve and necessitating removal of a considerable amount of osseous structure thus increasing the risk of a mandibular fracture. Alternative techniques for such lesions include an extra oral approach but one which could potentially create a cosmetic defect from cutaneous scarring and can result in facial nerve injury. This case report describes the use of a unilateral sagittal split osteotomy (SSO) in the removal of a mandibular cementoblastoma. This is a safe and effective technique allowing optimal access to the tumor with complete visualisation, identification and protection of the inferior alveolar nerve with minimal bone removal while maintaining mandibular integrity, strength and facial aesthetics.

Selection of operative approach in children with Currarino syndrome

To summarize the experience of surgical treatment of children diagnosed with Currarino syndrome, with an emphasis on the selection of an optimal operative approach. The clinical materials of patients diagnosed with Currarino syndrome were recorded. Special attention was given to the operative management, particularly the different routes for operation. The type of ARM was the critical point. The Rintala score was used for the evaluation of bowel function. The medical records of 26 patients were reviewed. Seven were male, and 19 were female, with a mean age of 19.38 ± 13.80months. The standard posterior sagittal approach (SPS) group included three perineal fistulae, one anal stenosis, one retraction of the rectum after anoplasty for vestibular fistula, one ARM with no fistula, one rectourethral fistula, and one cloaca. In the limited posterior sagittal approach (LPS) group, there were 13 perineal fistulae, one displacement of the rectum, and one retraction of the rectum after anoplasty for the vestibular fistula. In addition, the transanal approach (TA) and anterior sagittal approach (AS) were also used. The mean follow-up time was 39.48 ± 26.84m. The Rintala score was 16.74 ± 2.93. For a perineal fistula, SPS or LPS should be used to reach anoplasty and remove the presacral mass. For a vestibular fistula, the AS or LPS should be chosen. For anal stenosis, SPS or LPS should be used.

Delayed vs. early enteral feeding after repair of congenital recto-vestibular fistula: The effect on perineal wound healing.

congenital Recto vestibular fistula represents the commonest type of anorectal malformation in females. The treatment of this anomaly is mainly approached either through anterior or posterior sagittal ano-rectoplasty approach. Several perioperative factors may affect the outcome. One of major postoperative complications is the occurrence of wound infection. We aimed to study the effect of delayed vs. early enteral feeding on the occurrence of perineal wound infection (PWI) after repair of congenital recto vestibular fistula. Fifty-five infants with recto-vestibular fistula were included. They were managed by single stage anterior sagittal anorectoplasty (ASARP) at an age ≥3 months. Groups A and B included infants who started oral intake on the 6th and 2nd postoperative days respectively. Group A infants were kept on peripheral parenteral nutrition (PPN) during the fasting period. Superficial wound infection occurred in three cases in group A while it developed in seven cases in group B. Deep perineal infection occurred in two and five cases in group A and group B respectively. The mean hospital stay was 8 days in group A vs. 13 days in group B when PWI developed. Delayed enteral feeding with PPN keeps the perineal wound less contaminated with stool. This promoted proper and fast healing with lower incidence of PWI. Also, PPN compensates the catabolic effects of both surgical trauma and fasting during the postoperative period and ensures maintenance of normal levels of essential nutrients that allow for proper healing.

Neonatal Rectal Duplication Cyst: A Rare Presentation

Rectal duplication cysts are a rare clinical entity accounting for 4% of all intestinal duplications. The presenting symptoms depend upon their size, location and age of the patient. We report a rare neonatal presentation of rectal duplication cyst which was present as a swelling in the infracoccygeal region in a female child since birth. MRI suggested a cystic swelling adjacent to the rectum. Excision was done by posterior sagittal approach at 1 month of age. Histopathology confirmed it to be a rectal duplication cyst.

ILIF ASSISTIDA POR ENDOSCOPIA POR VIA TRANSILÍACA: ESTUDO EM CADÁVER

ABSTRACT Objective: Demonstrate the feasibility of endoscopic assisted L5S1 intraforaminal lumbar interbody fusion (iLIF) through a transiliac approach. Methods: Ten transiliac iLIF and ten supra iliac iLIF were performed bilaterally at L5S1 in five randomly selected fresh-frozen human cadavers. The following measurements were recorded: distances from the transiliac track to the iliac crest, posterior superior iliac spine, and superior gluteal neurovascular bundle; pelvic parameters; approach angles; cage’s lateral and AP center point ratio (CPR); percentage of the cage crossing the midline in the AP and lateral views. Endplate integrity was assessed through endoscopic visualization. In addition, the facet joint, sacroiliac joint, iliolumbar ligament, and exiting and traversing nerve roots were checked for integrity through anatomic dissection. Results: In the transiliac technique, the axial and coronal approach angles were significantly decreased by 13.5º (95% CI -15.5; -11.5; p value&lt;0.001) and 13.2º (95% CI -15.3; -11.1; p value&lt;0.001), respectively, the sagittal approach angle was significantly increased by 5.4º (95% CI 1.8,8.9; p-value = 0.008), and the AP CPR was significantly higher (MD 0.16; 95% CI 0.12,0.20; p value&lt;0.001). The percentage of the cage crossing the AP view’s midline was increased by 31.6% (95% CI 19.8,43.4; p value&lt;0.001). The integrity of endplates, facet joints, sacroiliac joints, iliolumbar ligament, and exiting and traversing nerve roots was maintained. Conclusion: L5S1 transiliac iLIF is a feasible surgical technique. It allows a more centrally placed interbody cage in the coronal plane without compromising the anterior position in the lateral plane. The integrity of the major anatomic structures at risk was preserved. Evidence Level III: A case-control study.

Redo pull-through for postoperative complications following pull-through in Hirschsprung disease: a single center experience.

Although surgical management of Hirschsprung disease (HD) is effective in most patients, some patients experience long-term postoperative complications, and require redo pull-through (PT). The present study evaluated clinical outcomes of redo PT in HD patients at a single center. Patients with HD who underwent redo PT procedures between 2003 and 2019 were retrospectively reviewed. Thirteen patients were included. Five (38.5%) had undergone initial PT surgery at our center and 8 (61.5%) at other centers. Redo PT procedures were transanal endorectal PT in 12 patients (92.3%) and the posterior sagittal approach in 1 patient (7.7%). Indications for redo PT included pathologic misdiagnosis in 8 patients (61.5%); stricture in 2 (15.4%); and rectal stenosis, obstructing Duhamel pouch and remnant septum in 1 each (7.7%). At a median follow-up of 68 months (range, 3-227 months) after redo PT, 8 patients (61.5%) had normal bowel function, 2 (15.4%) had incontinence, and 1 (7.7%) had constipation. Redo PT procedures could be an effective approach for improving obstructive symptoms in HD patients with anatomic or pathologic reasons following primary PT. Careful selection of patients and discreet indications for redo PT are crucial.

Posterior Sagittal Approach for Nonanorectal Malformation: Widening Spectrum.

Posterior sagittal is a very well accepted approach in the treatment of anorectal malformations. This approach provides good access and exposure through the perineum to the deep pelvic structures. It reduces risk of injury to important structures as dissection remains in midline. To access feasibility of posterior sagittal approach for non-anorectal malformation indications and to widen the spectrum. We present a series of 10 cases of non-anorectal malformations operated by this approach for 4 years. Six patients included in the study were of Disorders of Sexual Differentiation with pseudovagina, three of Y duplication of the urethra, and one of cervical atresia. All patients had good results. Posterior sagittal approach is feasible, safe with minimal bleeding, and no postoperative incontinence. It can safely be used for non-anorectal indications.

Rectal Atresia an uncommon entity: Experience of three cases

Background: Rectal atresia (RA) is a unique and rare congenital malformation contributing to about 1% of anorectal malformations. It may be associated with an abnormal sacrum and a presacral mass. The sphincter mechanism in these cases is well developed. Different surgical procedures have been described for correction of this anomaly, with variable outcomes. Case Presentation: We present three cases of rectal atresia with their management. All the patients presented in early neonatal life with failure to pass meconium. All the patients underwent colostomy in neonatal life as initial management. Definitive surgery was performed later in all patients. All the patients are doing fine on follow-up with good continence. Conclusion: The Posterior Sagittal Approach with the division of septum/tissue between the rectum and anal canal and end-end anastomosis gives excellent results.