Posterior Sagittal Anorectoplasty (PSARP)

Our surgeons and their teams have years of experience performing PSARP on infants and young children, which reduces the risk of rare, potential problems. If a problem occurs, we quickly take steps to protect your child’s health.

Your child’s care team will discuss possible risks with PSARP surgery with you before the procedure. In general, risks may include:

• Bleeding from the surgical site
• Infection after surgery
• Reaction to anesthesia (medicine to put your child into a sleeplike state for surgery)
• Excessive pain
• Breakdown of the wound
• Stricture (narrowing) of the new anus

In the long term, children who had an ARM may develop constipation or fecal incontinence (soiling and accidents), even with successful PSARP surgery. These children may benefit from our bowel management program .

At Children’s Health, our surgeons have the expertise to correct an ARM in a single-stage operation, whenever possible. A PSARP procedure may be the only surgery your child needs for an ARM, depending on the type they have. We work closely with you and your family to help you understand your child’s specific needs and decide on the right treatment options for them.

What to expect before PSARP

If necessary, your child may have surgery to create a colostomy within days after birth. This procedure creates an opening in the belly that connects to the large intestine. Your child will have a collection bag attached to the opening to allow stool to exit the body.

A colostomy doesn’t affect your child’s eating and digestion, and your child can continue to grow before the PSARP procedure. This colostomy is temporary until after your child has healed from that procedure.

What to expect during PSARP

Your child will have anesthesia for the procedure, so they go to sleep and don’t feel any pain. Surgeons make an incision between the buttocks to access the entire anal sphincter area.

In certain situations, the surgeon may also perform surgery through the abdomen (belly) if there is an abnormal connection between the rectum and urinary tract (fistula) that cannot be reached from the bottom. Learn more about this procedure, called laparoscopic pull-through for anorectal malformations.

The surgeons separate the rectum from other internal structures and position it within the sphincter muscles to provide the best chances for bowel control. The surgeons then attach the sphincter muscles around the rectum to create an anal opening. During the operation, the surgeons will also ensure that no other urological or reproductive problems need repair.

What to expect after PSARP

Most children are able to leave the hospital within a few days after PSARP surgery. A few weeks after PSARP surgery, you may need to perform anal dilations to help prevent scar tissue from closing the newly created anus. Your child’s care team will teach you how to perform dilations, which you will do at home until the anal area heals.

If your child had a colostomy as the first stage of reconstructive surgery, it will stay in place after PSARP surgery because it allows the anal area to stay clean of stool while healing. Once the area has healed, your child will have another surgery to close the colostomy. Stool will then pass through your child’s large intestine and out of the body through the rectum and anus.

Your child’s care team will explain how to prepare your child for surgery. Here are some general steps:

• Children with certain types of ARMs need to go to the hospital the day before surgery for a bowel prep.
• If your child does not need to go to the hospital the day before surgery, the nurse will call you 48 hours (2 days) before the surgery date. They will explain:
  • Guidelines for your child’s food and drink
  • What time you need to arrive at the hospital
• If your child takes medicine, ask the care team whether they should stop or keep taking it before surgery. Don’t give your child any medicine on the morning of surgery unless your child’s care team tells you to.
• On the day of surgery, the care team will make sure your child is ready for surgery.