Rectal Atresia - a Unique Anorectal Malformation
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
A narrow anal opening in normal sphincter position can represent either anal stenosis or rectal atresia
In cases of narrow anal opening, one must screen for Currarino triad
In cases of narrow anal opening, one must ensure there is no associated presacral mass
Presacral masses associated with anorectal malformations are usually teratoma or meningocele
Rectal atresia should now be treated like Hirschsprung's disease
If the rectum is high in rectal atresia, laparoscopy can be used to mobilize it
If the rectum is low in rectal atresia, it can be approached transanally only
The transanal approach to rectal atresia is very different from the previously described posterior sagittal approach
The surgeon can avoid a posterior sagittal incision and reach the rectum transanally using a Swenson technique
Transanal dissection for rectal atresia begins with incision 0.5 centimeters proximal to the dentate line
The mobilized distal rectum is anastomosed to the anal canal, just like in a case for Hirschsprung's disease
The dissection must find the typical whitish fascia that surrounds the rectum, just like for all PARPs, for a Swenson plane mobilization
On the anterior side of the dissection, the surgeon must be careful not to hurt the urethra by staying right against the rectal wall
Sutures placed at 12, 3, 6, and 9 o'clock help manage size discrepancy between the rectal lumen and anal canal during anastomosis