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Article
Posterior sagittal anorectoplasty (PSARP).A new approach for treating anorectal malformations.

Authors: Kutiaba yahya --- Nawfal.S.Dawood
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2006 Volume: 48 Issue: 4 Pages: 348-352
Publisher: Baghdad University جامعة بغداد

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Abstract

Background:-Anorectal malformation is a congenital anomaly of different varieties and its correction needs good experience , knowledge about this varieties and specific surgical tools, otherwise the child may lose his the only chance to live normally without disastrous complication like incontinence.
Objective:-assessment of the advantage of this procedure in management of anorectal malformations and the percentage for anal continence.
Patients and methods:-. This study was carried out in the child's central teaching hospital in Baghdad total number (70) cases were included in the study, 37 males and 33 females: aged 7 days to 6 years. They attended the hospital between October 1998-october 2004.
•Male defect included:¬
1) Low type ....5 cases No colostomy needed.
2) Intermediate type.... 23 cases. needed colostomy
3) High type.... 9 cases needed colostomy.
•Female defects:¬
1) Imperforate anus with vestibular fistula---31 cases.
2) Imperforate anus without fistula 2 cases.
Results:¬ From the study we gain the following results:- all the male patients with low and intermediate types 28 cases (40%) show 100% continence. All female patients with imperforated anus with vestibular fistula and without fistula 33 cases (47%) show 100% continence. The combination of male and female patients show 61 patients of 70 show 100%continence in a percentage of 87%. The nine cases (12.85%) with recto bladder neck fistula show poor continence due to their bad sacral contour associated with the poor development of pelvic muscles sphincter. This result was revealed from follow-up together with the presence of external sphincter muscle contraction which occurs during digital PR examination or by the use of surgical dilators.
Conclusion:¬ From the study we found that this procedure gives high percentage of continence and should be used instead of other procedures.


Article
Does fecal continence improve with time after posterior sagittal anorectoplasty for high type imperforate anus?

Author: Ahmed Zubar Zain
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 2 Pages: 30-33
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: anorectal malformation represent a spectrum of defects, which may be benign, non complex with a good functional prognosis, to more severe malformations involving the genitourinary system with poor prognosis for bowel and urinary function. Aim: to assess fecal continence after posterior sagittal anorectoplasty (PSARP) with its relation to the post-operative time and to describe the complications of PSARP. Patients and method: this prospective study was conducted in the pediatric surgery department of Al-Kadhymia teaching hospital. The duration of the study was five years from 1st January 2009 to the 31st December 2013.Kelly's methods was applied for assessing the grade of continence after 6 months, one year, and two years after closure of colostomy. Also we describe the complications of PSARP after closure colostomy. PSARP was performed according to Pena method & the results were evaluated after colostomy closure. Results: forty patients with high type imperforate anus were included in this study. They were 25 males (62.5%) and 15 females (37.5%). Genitourinary anomalies were the commonest associated anomalies. There was no accidental defecation in 12 cases (30%) after six months, and 15cases (37.5%) after two years, while there was constant defecation in 4 patients (10%) after 6 months , in 3 patients(7.5%) after 1 year, and in two patients (5%) after two years. Wound infection was the commonest complication and occurred in 8 patients (20%), followed by rectal prolapse in 7 patients (17.5%). Conclusion:Initial poor results should not discourage the surgeon as the condition of the patient and grade of the continence keeps improving as child grows.

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