MODIFIED POSTERIOR SAGITTAL ANO-RECTOPLASTY: A NEW APPROACH FOR THE MANAGEMENT OF ANO-RECTAL MALFORMATIONS IN CHILDREN

Objectives: To introduce a technical modification in Posterior Sagittal Ano-rectoplasty (PSARP), commonly known as Penaʹs procedure, and to analyse the outcome of such modified procedure in terms of fecal continence and other relevant complications in children with ano-rectal malformations. Methodology: It was a prospective and descriptive study, conducted at the department of pediatric surgery, Lady Reading Hospital Peshawar from January 2004 to December 2006. Forty patients were studied. All children of either sex with ano-rectal malformation who presented first to our department were included in our study excluding others treated some where else. Relevant investigations were performed in all patients. Diverting colonic or small bowel stoma was created in all patients at presentation to our department. The technique was performed at or after six months of age, depending upon the clinical condition of the patient. After discharge, all patients were examined and monitored in the out-patient department over a period of two years. Results: Out of 40 patients 25(62.5%) were male and 15 (37.5%) were female age range from 6-12 months. On 35 (87.5%). Isolated PSARP while on 5 (12.5%) patients modified PSARP with abdominal approach were performed. Anal stenosis was found in 3(7.50%) patients, rectal mucosal prolapse in 4(10%), faecal soiling and faecal incontinence in 17(43.58%) and 7(17.05%) patients were respectively. Faecal continence was good, fair and poor in 15(38.46%), 17(43.58%) and 7(17.94%) patients respectively. Conclusion: Our results of the present series suggest that this procedure is a valuable alternative to PSARP for the treatment of anorectal malformations.