Sphincter‐saving anorectoplasty for correction of anorectal malformations

Abstract

Aim: Posterior 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 Methods: This 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. Results: During 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. Conclusion: SSARP technique is a safe and effective approach in correction of ARM with acceptable postoperative complications.

Outcomes after Surgical Treatment for Rectal Atresia in Children: Is There a Preferred Approach? A Systematic Review

“…In total, four case series and 18 case reports were included, comprising a total of 70 patients with RA (37 males, 21 females, and 12 unknown 4 5 7 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 ). Age at definitive surgical correction ranged from 1 day (after full-term gestational age) to 6 years of age.…”

“… 4 30 The other two of four studies were of moderate quality with scores of 20 and 22, respectively. 28 40 No studies were of low quality. An overview of individual methodological quality assessment of included studies is provided as Supplementary Table A4 (available in the online version only).…”

“…In 4 of 56 patients, a postoperative complication was noted (i.e., anal stenosis [ n = 1], anastomotic stenosis [ n = 2], and death [ n = 1]). 4 5 7 24 25 26 28 30 32 34 36 37 38 39 40 41 Clavien–Dindo scores per postoperative complication are shown in Table 2 .…”

“…In general, 18 of 22 studies reported functional outcomes for (some) included patients, comprising 52 of 70 patients. 4 5 7 24 25 26 28 30 31 32 34 35 36 37 38 39 41 42 For bowel and urinary function, follow-up ranged from 2 months to 15 years after definitive correction of RA ( Table 1 ). However, timing of follow-up was not mentioned in three studies, comprising four patients.…”

“…and death [n ¼ 1]). 4,5,7,[24][25][26]28,30,32,34,[36][37][38][39][40][41] Clavien-Dindo scores per postoperative complication are shown in ►Table 2.…”