[Posterior sagittal anorectoplasty (PSARP) in children with high anal atresia]. / Posteriorna sagitalna anorektoplastika (PSARP) u djece s visokom atrezijom rektuma.

ABSTRACT

Anorectal anomalies are highly significant (the incidence of 13000 infants). The knowledge of the factors related to fecal continence encouraged the introduction of new surgical approaches in the second half of this century. With high supralevator anorectal anomalies the percentage of incontinence in children was earlier 50-80% although in all surgical procedures efforts were made to reconstruct the normal anatomy of the small pelvis. It was only in 1982 that by the PSARP method the anatomic reconstruction was achieved. In this operation an electric stimulator is used to identify the entire muscle-sphincter complex (external sphincter, the cross-striated muscle complex and the levator musculature) and then by stimulation of muscles a mobilized and modeled rectum is inserted into the muscle-sphincter complex. During the ten-year application of the PSARP method 15 children underwent the operation, of which 14 boys and 1 girl. The girl had rectovaginal fistula and 11 boys had rectourethral fistula. More than 70% of our children showed accompanying anomalies. Control examinations of children older than 3 years show the 67% continence in our children operated by the Pena-de Vries method.