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PSARP

perineal sagittal anorectoplasty


DESCRIPTION
• Pena procedure
• performed in the prone jackknife position. If the fistula is high, it
occasionally will be necessary to turn the patient over for abdominal
mobilization of the sigmoid colon.
SURGICAL APPROACH
• Imperforate anus anomalies are classified as high or low, depending
on whether the distal rectum ends above or below the levator muscle
• If the fistula terminates on the perineum, it is called a “perineal
fistula”or “anterior anus.”
• The operation is then performed according to the estimated site of
the fistula. Low lesions are dilated or repaired; high lesions are
treated with a divided RLQ or loop colostomy
Anesthetic Consideration
• Pre-operative
- Children with rectal or anal agenesis without fistula will have had
colostomies in newborn period.
• Intra-operative
- Combined epidural/GETA, warm OR to 75°–80°F; heating pad on OR table
- Induction : Mask induction
- Maintenance : Low-dose volatile agent and air/O2 with muscle
relaxation for majority of cases.
• Post-operative
- Pain score : 6-7

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