From minimal, limited, to maximal posterior: Sagittal anorectoplasty-A 10-year experience in treating anorectal malformations

Posterior sagittal anorectoplasty (PSARP) has been increasingly accepted as the preferred procedure in treating anorectal malformations since Pena and de Vries published their experience in 1982. From 1985 to 1995, 125 cases of anorectal malformations were operated at this Institution, using this procedure either primarily (105 cases), or secondarily (20 cases). For imperforate anus with perineal fistula (n=32, 30.5%), minimal PSARP, which means only the external sphincter muscle is divided, was carried out. For imperforate anus without fistula (n=29, 27.6%) and for those with vestibular fistula (n=18, 17.1%), limited PSARP, defined as division of both the external sphincter and part of the muscle complex, was carried out. For imperforate anus with urethral fistula (n=13, 12.4%), those with vaginal fistula (n=l, 1.0%) and those with persistent low cloaca (cloaca length <3 cm, n=2, 1.9%), maximal PSARP, which is defined as division of all the external sphincter, muscle complex and part of levator muscle, was perform- ed. For imperforate anus with bladder neck or vesical fistula (n=7, 6.7%) and those with high cloaca (cloaca length>3 cm, n=3, 2.9%), in addition to the maximal PSARP, an abdominal approach has to be added in order to divide the fistula and gain adequate length of rectum or vagina. It is concluded that a uniform posterior sagittal approach with individual decision concerning different degrees of division of continent muscles can be applied comfortably to treat the entire spectrum of anorectal malformations.