Laparoscopic Assisted Posterior Sagittal Anorectoplasty
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
How I Do It Levitt PSARP
7 min · Published Sep 2016
Video
Rectal Prolapse Repair Following a Posterior Sagittal Anorectoplasty
4 min · Published Jan 2025
Video
Posterior Rectal Advancement Anoplasty (PRAA) in a male with an anorectal malformation and rectoperineal fistula
9 min · Published Mar 2026
Podcast
Anorectal Malformations Complications
Marc Levitt · 48 min · Published Feb 2016
Podcast
Anorectal Malformations Complications
Marc Levitt · 48 min · Published Feb 2016
Video
Problematic Anorectal Malformation Cases: Pediatric Colorectal Controversies...
13 min · Published Apr 2012
Video
Sphincter Reconstruction in a patient who suffered from Fournier’s gangrene
5 min · Published Mar 2026
Video
Total colonic Hirschsprung disease: Ileostomy take down and ileoanal pull-through
9 min · Published Mar 2026
Podcast
Colorectal Quiz: Episode 50 - 16th Annual European Pediatric Colorectal and Pelvic Reconstruction Conference, Stockholm, Sweden, October 2025 - What did we learn?
24 min · Published Mar 2026
Video
Turnbull Stoma
4 min · Published Feb 2026
Video
Rectal Atresia - a Unique Anorectal Malformation
4 min · Published Oct 2025
Video
Enhancing Urethral Meatus Creation in Cloacal Malformations: A New Technique
4 min · Published Aug 2025
What the experts said
A fistula entering the deltoid or shoulder region of the urethra is a bladder neck fistula
A fistula entering the triceps or humerus area of the urethra is a prostatic fistula
A fistula entering at the elbow of the urethra is a bulbar fistula
The laparoscopic view alone does not help the surgeon know where the distal rectum enters the urinary tract
A properly done distal colostogram is required to determine where the distal rectum enters the urinary tract
A high rectum with fistula to lower prostatic level where the rectum is above the pubococcygeal or PC line is amenable to a laparoscopic approach
A lower rectum with fistula to the bulbar urethra is ideal for a posterior sagittal approach
The laparoscopic setup uses a 5 millimeter port at the umbilicus for the camera, which is then moved to the right upper quadrant for best visualization of the pelvis
The sphincter is marked with silk sutures after defining its extent using an electrical stimulator
Muscle relaxant is provided by the anesthesiologist once the sphincter has been marked
The laparoscopic dissection stays intimately attached to the rectal wall, preserving the IMA in its arcade
The intramural blood supply profuses the rectal wall
Redundancy in the sigmoid indicates the colostomy was correctly opened in the proximal sigmoid, leaving the distal aspect for the pull through
Dissection continues until the rectum tapers into a narrow fistula
The goal is to have the tapered fistula area be the size of a 3 millimeter Maryland grasper
Dissection up to the stoma frees the rectum so the pull through will not be under any tension
Before ligating the fistula, the perineum is opened at the intended location of the anoplasty
Blunt, gentle dissection finds the path into the pelvis which will be the trajectory of the pull through
The fistula is ligated by preloading the Maryland grasper over an endo loop
The distal rectum is cut with sharp scissors and the urinary tract is closed with the endo loop
The anoplasty is created with tacking of the posterior rectal wall to the edge of the muscle complex