J.Jpn. Surg. Soc.. 88(9): 1287-1290, 1987
Report on the annual meeting
ABDOMINO-EXTENDED SACROPERINEAL APPROACH IN HIGH-TYPE ANORECTAL MALFORMATION AND IT'S RESULTS
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Department of Pediatric Surgery, School of Medicine Keio University, Tokyo, Japan Jotaro Yokoyama, Tatsuo Kuroda, Seichi Hirobe, Shinichi Hara, Masao Endow, Keizo Katsumata |
In the first step, mucosal stripping between rectal muscle and submucosal layer is carried out to preserve the pelvic nerve plexuses as in Rehbein's method. The second step is via the extended-sacroperineal approach and completes mucosal stripping to the rectourethral fistula, and allowing identification of the sphincter components by electrical stimulation under direct vision. In final step of abdominoperineal approach, the colon is pulled through to the perineum using the Penrose drain as a guide.
Good anorectal angulation has been demonstrated by postoperative defecogram. While, post-operative CT-scanning showed that the pulled through colon is localized in the center of each sphincteric component. Follow-up study has shown that using the Japan Study Group of Anorectal Anomalies for assessment of continence, five out of six cases with rectourethral fistula have excellent continence up to seven years after surgery.
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