Rectal atresia and anal stenosis: the difference in the operative technique for these two distinct congenital anorectal malformations

Abstract

Rectal atresia and anal stenosis are rare forms of anorectal malformations. The aim of the definitive surgical repair in such cases is to preserve the anal canal, the dentate line, and the sphincter complex. We present a case of rectal atresia and anal stenosis to demonstrate the differences in the operative repair. The techniques described leave the anterior wall of the very distal anal canal untouched in both rectal stenosis and anal atresia; however, the dissection of the rectum differs. The atretic rectum in rectal atresia is mobilized and sutured to the anal canal circumferentially. In anal stenosis, the posterior rectum is mobilized in the form of rectal advancement, and the posterior 180° is anastomosed directly to the skin (as in a standard PSARP) with preservation of the anal canal as the anterior 180° of the final anoplasty. These patients have an excellent prognosis for bowel control and fecal continence, and therefore, complete mobilization and resection of the anal canal must be avoided.

Delayed presentation of congenital rectal stenosis associated with Down's syndrome and hypothyroidism: Case report

“…3 , 26 Various surgeries have been described to treat rectal atresia and stenosis. 1 , 7 , 27 Usually, rectal atresia is operated through a posterior sagittal approach after a divided colostomy. The anal canal is split longitudinally and a primary anastomosis is performed between the upper pouch and lower anal canal after excision of the membrane that separates the two canals.…”

“…The anal canal is split longitudinally and a primary anastomosis is performed between the upper pouch and lower anal canal after excision of the membrane that separates the two canals. 3 , 27 Rectal stenosis may be treated with a Heineke–Mikulicz type repair. 1 Rectal stenosis may also be treated with dilatation if presents early.…”

Rectal Atresia and Congenital Hypothyroidism: An Association or Coincidence?

“…Many operative approaches are used to correct this unique malformation. 2 3 19 20 An alternative option consisting of treatment of rectal atresia with anastomosis using magnets has been reported. 21 However, the selection of the surgical technique depends on the presence of associated anomalies, presacral mass, pouch colon, and fistula.…”

Laparoscopically Assisted Anorectal Pull-Through versus Posterior Sagittal Anorectoplasty for High and Intermediate Anorectal Malformations: A Systematic Review and Meta-Analysis

“…Because of extensive perineal dissection in PSARP, favorable outcome is problematic [29]. With the development of small-size instruments and laparoscopic techniques in pediatric surgery, laparoscopically assisted anorectal pull-through (LAARP), gradually accepted by pediatric surgeons since 2000, was first introduced by Georgeson et al [6].…”