Does the posterior sagittal approach with perirectal dissection impair fecal continence in a normal rectum?

Pintér, Andrew; Hock, A; Vastyan, Attila M.; Farkas, A.

doi:10.1016/s0022-3468(96)90825-8

Cited by 15 publications

(10 citation statements)

References 11 publications

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“…The procedure PSAPD is still in use in our institution. The short-term results are similar to the ones we published in our previous report [9]. On the basis of our human material, the general belief that the posterior sagittal approach with perirectal dissection would impair sensation from anal canal leaving only proprioception and leading to fecal incontinence remains an open question.…”

Section: Discussionsupporting

confidence: 87%

“…The patient who died of tumor progression (prostatic rhabdomyosarcoma) 2 years after PSAPD was also continent both for feces and urine. These results have been partially published in our previous report [9].…”

Section: Short-term (24 Months) Follow-upsupporting

confidence: 78%

“…The median age at surgery was 6 years (range 8 months-13 years). All but one patient is the same who had been reported in our previous study and in whom early results had been published [9].…”

Section: Methodssupporting

confidence: 53%

“…In contrast with the good clinical results regarding PSAPD, Pena et al [3] and Pinté r et al [9] found in animal experiments that PSAPD resulted in severe changes in bowel and manometric parameters. The less favorable outcome of PSAPD in dogs can be explained by the fact that the surgical dissection was more extensive in dogs than in children.…”

Section: Discussionmentioning

confidence: 89%

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Posterior sagittal approach with perirectal dissection for reconstructive surgery of severe urogenital anomalies

et al. 2006

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There are many approaches for surgery of complicated congenital and acquired urogenital anomalies in children with intact rectum. Pena advocates the mid-sagittal division of the sphincter mechanism posterior and anterior to the rectum, along with opening of the posterior and anterior rectal walls. The aim of this study is to determine whether the posterior sagittal approach with perirectal dissection (PSAPD) and elevation of the mobilized rectum would impair fecal continence when used for correction of complicated urogenital anomalies in children with normal rectum. Between 1988 and 1994 the authors performed PSAPD in eight infants and children with an intact anorectum. Indications for PSAPD were high vaginal atresia, Mullerian duct remnants, prostatic rhabdomyosarcoma, and traumatic vesicovaginal fistula. After a mean 10-year follow-up the bowel habits were assessed. Anorectal and uromanometric studies and a detailed questionnaire (modified Holschneider's scoring) sent to children or parents were evaluated. Three patients who preoperatively were clinically fecal continent had soiling only at the time of diarrhea. Early postoperative low anorectal pressure profile normalized during the follow-up. Seven patients had a fecal continence score above 23, two of them with maximum points of 26. Only one girl had a low score of 15. The authors conclude the PSAPD which offers a few advantages over the sagittal division of the rectum provides an alternative approach for selected lesions of the genitourinary tract in children with a normal rectum. Our results suggest that fecal continence is either preserved or partially affected.

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Section: Discussionsupporting

confidence: 87%

Section: Short-term (24 Months) Follow-upsupporting

confidence: 78%

Section: Methodssupporting

confidence: 53%

Section: Discussionmentioning

confidence: 89%

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Posterior sagittal approach with perirectal dissection for reconstructive surgery of severe urogenital anomalies

et al. 2006

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“…19,20 Although Pinter et al observed that this procedure does not impair fecal continence, 19 we believe that rectal mobilization causes rectal denervation by destruction of the reflex arc between the rectum and striated muscle sphincters. 18 Moreover, in cases of a huge MDR, this approach is unsuitable because the anus limits the distal extent of incision.…”

Section: Discussionmentioning

confidence: 86%

Laparoscopic Removal of Müllerian Duct Remnants in Boys

et al. 2004

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Purpose: Mü llerian duct remnants (MDRs) are present in a male pseudohermaphroditic form characterized by failure of the mü llerian duct to regress due to insufficient production or peripheral action of mü llerian inhibiting substance. The MDR can be asymptomatic but it often results in infections, stones and voiding troubles. Furthermore, it may develop into a neoplasm. Therefore, surgery is mandatory for large MDRs and symptomatic patients. Laparoscopic removal is described.Materials and Methods: Six males were treated from February 1998 to February 2003. Age at surgery was between 3 and 18 years (mean 8.6). All patients showed severe hypospadias and 2 had mixed gonadal dysgenesis with ambiguous genitalia. Three patients presented with urogenital infections and all had a large MDR. Laparoscopic procedures, which were preceded by cystoscopy, were performed using a 10 mm umbilical trocar for the camera and 3, 5 mm trocars for instruments placed in the suprapubic region and iliac fossa bilaterally. The remnants were ligated with endoscopic loops or an endoscopic GIA stapler and cut.Results: Mean operative time was 2 hours. We noted no complications. In 2 cases there was deferential ectopia and in another of mixed gonadal dysgenesis bilateral gonadectomy was performed because of the risk of degeneration. Feeding started on postoperative day 1 and the patients were discharged home on day 5. After a followup of 8 months to 4 years all boys were healthy.Conclusions: Multiple approaches are used in traditional surgery, often leading to complications. Laparoscopy improves the view, decreases surgical risk and operative time, avoids large scars and allows more rapid hospital discharge.

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Origin of PSAM procedure in surgical oncology

Martucciello

2019

Journal of Surgical Oncology

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Does the posterior sagittal approach with perirectal dissection impair fecal continence in a normal rectum?

Cited by 15 publications

References 11 publications

Posterior sagittal approach with perirectal dissection for reconstructive surgery of severe urogenital anomalies

Posterior sagittal approach with perirectal dissection for reconstructive surgery of severe urogenital anomalies

Laparoscopic Removal of Müllerian Duct Remnants in Boys

Origin of PSAM procedure in surgical oncology

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