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These patients underwent PSARP (primary/staged) or Abdomino-perineal pull through procedures.
Neonatal PSARP versus staged PSARR: a comparative analysis.
Although it is difficult to infer any significance from only 6 patients in the primary PSARP group, there was a 66.7% complication rate.
The complication rate in the PSARP group was 40.9%.
Another patient died on next of PSARP following fits & fever at age of six months.
In one of them incomplete diversion of faeces was noted after PSARP. Other studies have reported incidence to be 8.35- 17%.1,12,15 The results of our series are comparable with these studies but are at variance with Saleem et al3 who have reported 1.87% incidence.
Dave et al [6] described a novel technique, The Neutral Sagittal anorectoplasty or NSARP as an extension of PSARP, which preserves both a perineal skin bridge between the neoanus and the posterior fourchette and the levator muscle.
18 girls had cloacal anomalies, 6 patients had undergone primary posterior sagittal anorectoplasty (PSARP).
While PSARP by Alberto Pena and Devries is popular since reported in 1980 (3,5) but the prone position is not a convenient and comfortable for dissecting the plane between rectum and vagina, which lies more anteriorly.
This case highlights the fact that even with late presentation of high type ARM (recto-vaginal fistula in our case) the three stage operative procedure is feasible which is why we first did a diversion colostomy followed by the second stage definitive repair, i.e, the PSARP operation and the third stage colostomy closure.
Sixteen patients had mesenteric fat pulled along with the bowel during PSARP, whereas in 10 of them there was no inadvertently pulled mesenteric fat detected on MRI.
The definitive procedure after colostomy was a posterior sagittal anorectoplasty (PSARP) in our series.