Pediatric posterior sagittal anorectoplasty (PSARP)

What is pediatric posterior sagittal anorectoplasty (PSARP) surgery?

A PSARP is a surgical procedure to repair several types of anorectal malformations (ARMs). An ARM is a congenital (present at birth) condition that occurs when a baby’s rectum and anus (lower end of the large intestine) don’t develop properly before birth.

In a PSARP, our surgeons perform reconstructive surgery through an approach from the bottom to create an opening through which a child can pass stool (poop). The procedure involves moving the rectum into the correct position and creating an anus within the child’s sphincter muscles. Children usually have PSARP surgery within the first few months of life.

What are the benefits of pediatric posterior sagittal anorectoplasty (PSARP) surgery?

The goal of PSARP surgery is to reposition the rectum into an ideal position with a normal anal opening while avoiding damage to nearby tissues, nerves, urinary tract and reproductive organs. This procedure will allow your child to pass stool naturally through an anus. Our pediatric colorectal surgeons are experienced in this procedure, which gives babies the best chance for good bowel control later in life.

What are the risks of pediatric posterior sagittal anorectoplasty (PSARP) surgery?

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.

What to expect with pediatric posterior sagittal anorectoplasty (PSARP) surgery

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 pediatric posterior sagittal anorectoplasty (PSARP) surgery

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 pediatric posterior sagittal anorectoplasty (PSARP) surgery

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 pediatric posterior sagittal anorectoplasty (PSARP) surgery

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.

What questions should I ask my provider about pediatric posterior sagittal anorectoplasty (PSARP) surgery?

• Are there other treatment options for the type of ARM my child has?

• What medications should my child stop taking before PSARP?

• How soon will I be able to see my child after PSARP?

• How long will my child need to stay in the hospital after PSARP?

• Will my child go home with any special equipment after PSARP?

• Children’s Health Colorectal and Pelvic Center: Patient Education Resources

• ONE in 5000 Foundation: Resources for the imperforate anus/anorectal malformation community

• The Rare and Resilient - ONE in 5000 Podcast: Podcast produced by the ONE in 5000 Foundation

• Youth Rally: Camp experience for youth living with conditions of the bowel and/or bladder system

• Parents magazine: 5 Lessons I've Learned From Parenting a Child With a Rare Disease

• Pull-Thru Network: Support for families of people born with an ARM, colon disease and associated issues

• United Ostomy Associations of America, Inc.: Support, empowerment and advocacy for people who have had ostomy and/or continent diversion surgery

• Imperforate Anus USA Support Group: Private Facebook group to support families of people who have imperforate anus