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Update Course Rewind: Perineal Body Sparing PSARP 2023

Video Published 2023-12-29 Updated 2026-08-22

Timestops (8)

Global Cat MD along with Cincinnati Children's Hospital

Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hel…

Today our topic is perineal body sparing peace art.

Today our topic is perineal body sparing peace art. Joining the discussions are Doctor Steven Lee. Caitlin Smith And Jul…

We have a one month old female seen in the doctor's office w…

We have a one month old female seen in the doctor's office with a diagnosis of a recto vestibular fistula. Rectal workup…

So, this is a very relatively new thing.

So, this is a very relatively new thing. There's a couple of papers that have come out this year. There's two variations…

The one you see here is the Boston technique.

The one you see here is the Boston technique. It shows us there's a slight posterior sagittal extension of the incision.…

This one out of DC is just an incision just through the sphi…

This one out of DC is just an incision just through the sphincter alone, preserving the perineal body skin in its entire…

In summary, according to the recent studies from Boston and Washington DC, there are new surgical techniques that aim to…

Follow our social media channels and download the Stay Curre…

Follow our social media channels and download the Stay Current MD app for tons of content in pediatric surgery. Global C…

Topic Overview

A panel discussion reviewing perineal body-sparing posterior sagittal anorectoplasty (PSARP) techniques for rectovesibular fistula repair in female infants. Two recent variations published in 2023—one from Boston with a posterior sagittal extension and one from DC using a sphincter-only incision—both aim to preserve the perineal body to protect long-term gynecologic function, sexual health, and obstetric outcomes. The techniques may also reduce postoperative infection risk in non-diverted patients undergoing preoperative dilations.

Key Takeaways

Two perineal body-sparing PSARP variations published in 2023: Boston (posterior sagittal extension) and DC (sphincter-only incision). (1:08)
Preserving the perineal body protects long-term sexual function and obstetric outcomes in female patients with rectovesibular fistula. (1:30)
Perineal body-sparing techniques may reduce postoperative infection in non-diverted patients undergoing preoperative dilations. (2:00)

Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Speaker 1 — host
Goddy — host
Steven Lee — guest
Speaker 4 — guest

Chapters

0:00Introduction — Introduction to the Update Course Rewind series and today's topic on perineal body-sparing PSARP.
0:45Case Presentation — One-month-old female with rectovesibular fistula, stooling well with dilations, no other anomalies, presenting for operative repair discussion.
1:03Perineal Body-Sparing Techniques — Discussion of two new perineal body-sparing PSARP variations published in 2023 from Boston and DC, their technical differences, and rationale for preserving long-term gynecologic and obstetric function.
2:00Clinical Benefits and Summary — Benefits of perineal body preservation including reduced postoperative infection risk in non-diverted patients and summary of key surgical principles.
2:35Closing — Closing remarks and channel subscription information.

Key claims

1:08Two variations of perineal body-sparing PSARP have been published in the last 6 months, one from Boston and one from DC. — Steven Lee
1:17One study has 6 patients and the other has 4 patients. — Goddy
1:20The techniques are similar but slightly different. — Goddy
1:26The Boston technique includes a slight posterior sagittal extension of the incision. — Steven Lee
1:30These techniques aim to spare the perineal body and preserve long-term gynecologic function for female patients. — Steven Lee
1:38The perineal body is important for sexual function and obstetric outcomes in the future. — Speaker 4
1:49The DC technique uses an incision just through the sphincter alone, preserving the perineal body skin in its entirety. — Steven Lee
2:00For non-diverted patients undergoing dilations, the perineal body seeing stool right away creates a setup for postoperative infection. — Speaker 4
2:29Perineal body-sparing techniques can reduce postoperative infection risks in patients undergoing dilations. — Goddy

Cases discussed

0:45One-month-old female with rectovesibular fistula presenting for operative repair discussion.

Open questions

Which perineal body-sparing technique (Boston vs DC) is preferred in different clinical scenarios?
What are the long-term functional outcomes comparing traditional PSARP to perineal body-sparing techniques?

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Perineal Body-Sparing PSARP: Two New Techniques for Anorectal Malformation Repair

The essential version of this episode — what it covers, the points that matter most, and what it changes for you. Written by Kai from the episode transcript and reviewed before publishing.

For trainees · Core brief · AI-written, human-reviewed

What This Episode Covers

Two variations of perineal body-sparing posterior sagittal anorectoplasty (PSARP) have been published in the last six months, one from Boston and one from DC 1:08. The Boston series includes six patients; the DC series includes four 1:17. Both techniques aim to preserve the perineal body during repair of anorectal malformations in female patients 1:30.

Technical Differences

The techniques are similar but not identical 1:20. The Boston approach includes a slight posterior sagittal extension of the incision 1:26. The DC technique uses an incision through the sphincter alone, preserving the perineal body skin in its entirety 1:49.

Why Preserve the Perineal Body

The perineal body is important for sexual function and obstetric outcomes in the future 1:38. These techniques specifically target long-term gynecologic function for female patients 1:30. As more patients with anorectal malformations reach adulthood, outcomes in these domains are becoming clearer.

Postoperative Infection Risk

For non-diverted patients undergoing dilations, the perineal body seeing stool right away creates a setup for postoperative infection 2:00. Perineal body-sparing techniques can reduce postoperative infection risks in patients undergoing dilations 2:29. This represents an immediate benefit in addition to the long-term functional preservation.

What This Changes

These are early reports with small numbers. The techniques are not yet standard, and surgeon comfort with the approach will vary. What matters for trainees is the rationale: the perineal body is not expendable tissue in female patients with anorectal malformations. Preservation may improve both short-term surgical outcomes and long-term quality of life in domains that matter to patients as they age.

Takeaways from this story

Two perineal body-sparing PSARP techniques (Boston and DC) have been published with small patient series in the last six months.
Preserving the perineal body targets long-term sexual function and obstetric outcomes in female patients with anorectal malformations.
Perineal body-sparing approaches may reduce postoperative infection in non-diverted patients undergoing dilations.

Keywords

rectovesibular fistula anorectal malformation PSARP posterior sagittal anorectoplasty perineal body-sparing PSARP dilations Cincinnati Children's Hospital Medical Center Boston DC

Hashtags

#pediatricsurgery #PSARP #perinealbody #rectovestibularfistula #childhealth #gynecologicfunction #surgicaltechniques #AnorectalMalformation #ColorectalSurgery

Transcript

Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello pediatric surgery family. I'm I'm Goddy, a research fellow from Cincinnati Children's Hospital Medical Center. Our 11th annual update course in pediatric surgery was held past August. In this video series, we'll recap the sessions and share the main highlights with you. Today our topic is perineal body sparing peace art. Joining the discussions are Doctor Steven Lee. Caitlin Smith And Julia Grabowski. Let's see our case. We have a one month old female seen in the doctor's office with a diagnosis of a recto vestibular fistula. Rectal workup is performed, and there is no other significant anomalies. She has been stooling well with dilations, and parents are in the clinic to discuss operative repair. And what would you do? As your repair. So, this is a very relatively new thing. There's a couple of papers that have come out this year. There's two variations of something called a perineal body sparing a PSARP that have come out in the last 6 months, one from Boston, one from DC. One of the studies has 6 and the other one has 4 patients. They're similar but slightly different techniques. The one you see here is the Boston technique. It shows us there's a slight posterior sagittal extension of the incision. These techniques that are being described are all about sparing the perineal body and preserving long-term gynecologic function for our female patients. The perineal body is really important for sexual function and obstetric outcomes in the future, especially as we see more of these patients as they age, and they are telling us how they're. are as adults. This one out of DC is just an incision just through the sphincter alone, preserving the perineal body skin in its entirety. Obviously you do which technique you're comfortable with, but it's important to think about for our patients as they age. And I think one thing that's nice is for the patient who is undergoing dilations and isn't diverted, that perineal body seeing stool right away is such a setup for a post-op infection that is like the bane of our. So I think this is a really nice way to avoid that. In summary, according to the recent studies from Boston and Washington DC, there are new surgical techniques that aim to spare the perineal body, which is crucial for long term gynecological function, sexual health, and obstetric outcomes. Also, preserving the perineal body can reduce post-op infection risks in patients undergoing dilations as well. Thank you for watching this video. Don't forget to subscribe to the Stay Current MD YouTube channel. Follow our social media channels and download the Stay Current MD app for tons of content in pediatric surgery. Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.

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