Sphincter saving anorectoplasty (SSARP) for the reconstruction of Anorectal malformations

Pratap, Akshay; Tiwari, Awadhesh; Kumar, Anand; Adhikary, Shailesh; Singh, Suren; Paudel, Bishnu Hari; Bartaula, Rajiv; Mishra, Brijesh

doi:10.1186/1471-2482-7-20

Cited by 8 publications

(13 citation statements)

References 18 publications

(22 reference statements)

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“…The central position of the rectum within the sphincter is crucial in ARM reconstruction. The use of preoperative and postoperative perineal ultrasound replaced computed tomography or magnetic resonance imaging, which was done in other studies, and minimized the risk of radiation to patients . The mean operative time of the SSARP procedure was 75.8 min ± 8.9 min, which was slightly longer than that reported by Pratap et al ., but accepted particularly in early cases using this technique .…”

Section: Discussionmentioning

confidence: 85%

“…Besides its cost and technical demand procedure, the passage of laparoscopy trocars through the perineum has the potential of injuring the urinary system. Pulling through the rectum without securing it to the muscle could also increase the incidence of postoperative rectal prolapse . In our view, SSARP avoids laparoscopy drawbacks, preserves the sphincter and accurately places the rectum within the sphincter, which was assured preoperatiely and postoperatively by ultrasound.…”

Section: Discussionmentioning

confidence: 86%

“…The use of preoperative and postoperative perineal ultrasound replaced computed tomography or magnetic resonance imaging, which was done in other studies, and minimized the risk of radiation to patients . The mean operative time of the SSARP procedure was 75.8 min ± 8.9 min, which was slightly longer than that reported by Pratap et al ., but accepted particularly in early cases using this technique . Rintala and Pakarinen reported that urinary incontinence was noted in one‐third of patients with high ARM using an abdominoperineal approach .…”

Section: Discussionmentioning

confidence: 99%

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Sphincter‐saving anorectoplasty for correction of anorectal malformations

Eltayeb

Shehata

2015

Surgical Practice

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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.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Sphincter‐saving anorectoplasty for correction of anorectal malformations

Eltayeb

Shehata

2015

Surgical Practice

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“…The reported continence rates vary from 2% to 84% (!). [2829303132] Neonatal high divided sigmoid colostomy in a distended abdomen of a sick baby is not devoid of complications and various authors have confirmed this. [333435] In developing countries, especially patients from low economic strata, the conventional policy of colostomy - PSARP – colostomy closure effectively means long duration of treatment, significant costs in terms of time and resources, difficult social environment, mental trauma to parents and ultimately, questionable continence results.…”

Section: Discussionmentioning

confidence: 99%

Anorectal malformations in males: Pros and cons of neonatal versus staged reconstruction for high and intermediate varieties

Menon

Rao

Sinha

et al. 2017

J Indian Assoc Pediatr Surg

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Background:High and intermediate types of anorectal malformations (ARMs) in male neonates may be managed either by primary neonatal reconstruction without colostomy cover or by traditional policy of staged reconstruction after neonatal colostomy. Posterior sagittal anorectoplasty (PSARP) is the current widely practiced reconstructive technique with varied results.Aim:To assess our functional results of PSARP without colostomy in male neonates with high and intermediate ARMs compared to 3-stage (neonatal colostomy – PSARP – colostomy closure) methodology in a high volume tertiary care institution of a developing country.Patients and Methods:The number of colostomies performed for male high/intermediate anomalies and the number of babies who completed 3-stage reconstruction during a 10-year period is analyzed. The outcome of primary neonatal PSARPs during the same period was analyzed. Eighty primary PSARPs were compared to 81 staged reconstructions for outcome analysis, using Kelly score.Results:A total of 453 colostomies were performed, but only 253 of them completed all stages of reconstruction (52%). Good continence was achieved in 45% of cases of primary PSARP versus 26% in 3-staged surgery.Conclusions:Primary PSARP in neonatal period without colostomy is a good option for high and intermediate ARMs in males if the treating surgeon is reasonably skilled in neonatal surgery and PSARP procedures.

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“…Levator ani muscle contains puborectalis, pubococcygeus, and iliococcygeus; and of them, puborectalis is the most important component part [11]. As early in 1953, Stephens and Smith [12] introduced that puborectalis played a key role in postoperative fecal continence in ARM patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical value of pelvic 3-dimensional magnetic resonance image reconstruction in anorectal malformations

Tang

Cao

Mao

et al. 2009

Journal of Pediatric Surgery

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Sphincter saving anorectoplasty (SSARP) for the reconstruction of Anorectal malformations

Abstract: Background: This report describes a new technique of sphincter saving anorectoplasty (SSARP) for the repair of anorectal malformations (ARM).

Cited by 8 publications

References 18 publications

Sphincter‐saving anorectoplasty for correction of anorectal malformations

Sphincter‐saving anorectoplasty for correction of anorectal malformations

Anorectal malformations in males: Pros and cons of neonatal versus staged reconstruction for high and intermediate varieties

Clinical value of pelvic 3-dimensional magnetic resonance image reconstruction in anorectal malformations

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