Letter to the Editor: Sphincter-Sparing Posterior Sagittal Anorectoplasty for Rectourethral Fistulas: A Potential Refinement to Consider?

jpedsurg.org

The introduction of Posterior Sagittal Anorectoplasty (PSARP) by Peña and deVries has undeniably revolutionized the management of anorectal malformations (ARMs) [1]. The technique's emphasis on complete visualization and meticulous fistula management has significantly improved outcomes, establishing it as a cornerstone in ARMs surgery. However, despite these advancements, fecal incontinence and soiling remain challenging complications, with complete fecal continence achieved in only 24 % of patients in the most recent and largest multi-institutional study [2].

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Article · Jan 2025 · 1 min read

In brief

This letter discusses potential refinements to the Posterior Sagittal Anorectoplasty (PSARP) technique for treating rectourethral fistulas in anorectal malformations. Despite PSARP's revolutionary impact, fecal incontinence remains a significant challenge, with only 24% of patients achieving complete continence, prompting consideration of sphincter-sparing modifications.

PSARP revolutionized ARM management through complete visualization and meticulous fistula handling.
Fecal incontinence remains a major challenge: only 24% achieve complete continence post-PSARP.
Despite PSARP's success, soiling and continence issues persist, warranting technique refinements.
Largest multi-institutional data shows suboptimal continence outcomes, highlighting need for innovation.

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