Posterior sagittal anorectoplasty (PSARP)/Pull-through :: Nationwide Children's Hospital

Posterior Sagittal Anorectoplasty (PSARP)/Pull-through

Posterior sagittal anorectoplasty (PSARP), also known as a “pull-through procedure,’ is a surgical technique used by our surgeons to correct a variety of anorectal and cloacal malformations. PSARP and variations of the procedure utilizing laparoscopic technology, provide greater accuracy in repositioning the rectum and anus, minimize damage to surrounding anatomical structures, reduce post-surgical pain and improve outcomes. Most pull-through procedures are done when a child is between one and six months old.
 
Marc Levitt, MD, the Surgical Director of the Center for Colorectal and Pelvic Reconstruction has performed over 2,000 pull-through procedures - the most of any practicing surgeon in the world. 
 
The exact type of PSARP procedure your child will have depends on if the defect is “high” or “low.” This describes where the rectum (the lower part of the intestine) ends within the abdomen, the quality of the pelvic sphincter muscles and if there is a fistula – an abnormal channel that develops between organs that can cause stool to pass into other parts of the abdomen. In males, this is usually between the rectum and the urinary system. 

Preparing for PSARP

Your child will likely need to have a distal colostogram – a type of X-ray - to help the surgical team see details about your child’s malformation that can help them plan the surgery. 

PSARP Post-Operative Care

Patients who undergo a posterior sagittal operation generally recover very well, with little pain. Children can usually leave the hospital within 1-3 days as long as they are able to eat, pass stool normally and do not have a fever. You will leave the hospital with detailed instructions for how to help your child recover. 

Two weeks after the pull-through surgery, parents should begin the process of anal dilations. The dilations prevent scar tissue from closing the newly created anus. The surgeon or pediatric surgical nurse will help you learn the dilation process, and you will be sent home with instructions. It is very important for the family to follow the dilation guidelines given to them. 
 
 
Once the anal dilation process is complete, your child’s colostomy closure can be performed. 

Contact the Colorectal Center

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