The effects of the posterior sagittal approach on rectal function (experimental study)

Peña, Alberto; Amroch, D.; Baeza, Carlos M.; Csury, Laszlo; Rodriguez, George

doi:10.1016/0022-3468(93)90323-d

Cited by 54 publications

(23 citation statements)

References 11 publications

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“…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: 92%

“…After correction of the urogenital tract, Pena [2] reconstructed both the rectal walls. However, Pena and his coworkers found that the posterior sagittal approach with perirectal (circumferential) dissection (PSAPD) resulted in severe changes in bowel and manometric parameters in animal experiments [3]. However, we hypothesized that PSAPD provides a suitable means of exposure for correction of complicated congenital or acquired anomalies of the genitourinary tract in children with an intact rectum without impairing fecal continence.…”

Section: Introductionmentioning

confidence: 95%

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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: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 95%

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

et al. 2006

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“…These structures may be divided without problems if the components are reapproximated accurately. An experimental animal study performed by Pena et al [26] showed that the division of the sphincters was an innocuous maneuver. Only those animals that underwent a perirectal dissection with a transected nerve supply to the rectum suffered from fecal incontinence and severe manometric abnormalities.…”

Section: Discussionmentioning

confidence: 99%

The Place of the Posterior Surgical Approach for Lesions of the Rectum

et al. 2005

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Background: Although there are many advantages of a posterior approach to rectal disease, these procedures are not widely accepted because many surgeons fear the postoperative complications. Methods: The medical records were reviewed of 57 patients who underwent a posterior approach to the rectum between January 1980 and December 2002. Results: Twenty-eight men and 29 women with a mean age of 70.5 (range 47–83) years underwent either a posterior transsacral (n = 52) or a transsphincteric (n = 5) procedure. Indications for surgery were benign lesions (n = 33), e.g. villous adenoma, rectal prolapse and endometriosis as well as invasive adenocarcinoma (n = 24). All patients with an invasive adenocarcinoma were classified as ASA grade III or IV. Postoperative morbidity occurred in 12 patients (21%), consisting of temporary incontinence, anastomotic leakage, wound infection, and hemorrhage. There was no mortality. During a mean follow-up of 29 (range 2–86) months, 3 patients with a villous adenoma and 2 patients who were treated for a malignant lesion had a locally recurrent lesion. Conclusion: We believe that a posterior approach to the rectum should be considered for various benign and selected malignant diseases, especially in case of elderly patients or patients with a compromised general condition, and has to be a part of the surgeon’s armamentarium.

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“…12 Limited PSARP, if associated with lot of perirectal dissection, is likely to cause the most severe changes in the external appearance of the anus, bowel control, and manometric parameters. [13][14][15][16] To conclude, we feel that the Anal Shift is a much simpler surgical procedure without too much perineal dissection and it gives the following benefits: (1) It preserves at least the anterior half of mucocutaneous junction of the original anus, thus, there are fewer chances of stenosis. (2) Dissection is not done laterally; therefore, neurovascular supply and lateral supports are practically not disturbed.…”

Section: Discussionmentioning

confidence: 99%