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  • 1. Introduction
  • 2. Incision
  • 3. Dissection to Distal Rectum
  • 4. Place Stay Sutures
  • 5. Open and Mobilize Distal Rectum
  • 6. Close Peritoneum
  • 7. Attach Ischiorectal Fat to Posterior Rectum
  • 8. Anoplasty
  • 9. Post-op Remarks
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Posterior Sagittal Anorectoplasty (PSARP) for Imperforate Anus


Paulo Castillo, MD1; Marcus Lester R. Suntay, MD, FPCS, FPSPS, FPALES2

1World Surgical Foundation
2Philippine Children's Medical Center

Main Text


Imperforate anus is a birth defect in which the anal opening is absent. This condition develops during the fifth to seventh weeks of pregnancy and the cause is unknown. It affects about one in every 5,000 newborns and is noted to be more common among boys than girls. Imperforate anus is usually present with other birth defects such as vertebral defects, cardiac problems, tracheoesophageal fistula, renal anomalies, and limb abnormalities, collectively known as the VACTERL association. These are classified as low or high type. In the low type, in which the rectum remains close to the skin, there may be associated stenosis of the anus, or the anus may be missing altogether, with the rectum ending in a blind pouch. In the high type, in which the rectum is higher up in the pelvis, there may be a fistula connecting the rectum and the bladder, urethra, or the vagina. The diagnosis is made by performing a physical exam after birth. An x-ray of the abdomen and abdominal ultrasound can help reveal the extent of the abnormalities. Treatment is surgical creation of an opening or new anus to allow stool to pass. The type of surgery differs and depends on whether the anus ends high or low in the pelvis. In the case of a low type, an anal opening is made in a single operation, and the rectum is pulled down to the anus. For high type, surgical correction is performed in three stages. The first procedure is bringing the intestine out of the abdomen creating a stoma; the second procedure is pulling the rectum down to the anus where a new anal opening is created; and the third procedure is closure of the intestinal stoma. Here, we present a case of a 9-month-old male who was born with a high-type imperforate anus. A posterior sagittal anorectoplasty (PSARP) was done as the second of three stages of treatment. The first was an emergency sigmoid colostomy, and the third will be to close the colostomy in about 6 to 8 weeks following the PSARP.

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