Posterior Sagittal Anorectoplasty (PSARP)

Anorectal malformations are birth defects in which the anus and rectum (the lower end of the digestive tract) did not develop properly. This can cause your child to have difficulty passing stool. The majority of babies with anorectal malformations will need to have surgery to correct the problem.

A PSARP is a type of pull-through procedure that is used to repair anorectal malformations in some children. This technique surgically creates the child’s anus within the sphincter muscle. Prior to surgery, if there is no opening for stool to come out, your child’s surgeon may use a type of X-ray called a colostogram to determine the severity and location of the malformation. The PSARP operation is usually done within the first year of your baby’s life.

Usually at birth, if needed, your child will already have undergone a colostomy procedure. In a colostomy, the large intestine is divided into two sections and the ends of intestine are brought through openings in the abdomen. The upper section allows stool to pass through the opening (called a stoma) and then into in a collection bag. The lower section allows mucus that is produced by the intestine to pass into a collection bag. By doing a colostomy, your baby’s digestion will not be impaired and they can grow before the time for the next operation.

PSARP is performed with your child under general anesthesia. During this procedure, your baby will be placed face down on the operating table. The surgeon will make an incision down the midline of your baby’s buttocks, between the cheeks. They will then separate the layers of muscle, fat, and connective tissue in the area until they locate the rectum. Your child’s surgeon will lift the rectum up and away from the urinary tract or vagina (in females) and surgically position it within the anal sphincter muscles to create an opening. During the operation, the surgeon will also ensure there are no vaginal anomalies (in girls) or urological anatomical issues (in boys and girls). Certain types of modifications also require an abdominal approach. Our surgeons like to do this with minimally invasive techniques.

Most children are able to leave the hospital within a few days of PSARP surgery. A few weeks after surgery, parents may start performing anal dilations to help prevent the scar tissue from closing the newly created anus. Your child’s clinician will teach you how to perform dilations. Once this process is complete and the new anus has healed — in about two months — an operation will be done to close the colostomy.