title: Rectal atresia and anal stenosis: the difference in the operative technique for these two distinct congenital anorectal malformations.
abstract: Rectal atresia and anal stenosis are rare forms of anorectal malformations. The aim of the definitive surgical repair in such cases is to preserve the anal canal, the dentate line, and the sphincter complex. We present a case of rectal atresia and anal stenosis to demonstrate the differences in the operative repair. The techniques described leave the anterior wall of the very distal anal canal untouched in both rectal stenosis and anal atresia; however, the dissection of the rectum differs. The atretic rectum in rectal atresia is mobilized and sutured to the anal canal circumferentially. In anal stenosis, the posterior rectum is mobilized in the form of rectal advancement, and the posterior 180° is anastomosed directly to the skin (as in a standard PSARP) with preservation of the anal canal as the anterior 180° of the final anoplasty. These patients have an excellent prognosis for bowel control and fecal continence, and therefore, complete mobilization and resection of the anal canal must be avoided.
authors.affiliation: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43201, USA. vic5lane@gmail.com.
authors.forename: V A
authors.initials: VA
authors.lastname: Lane
authors.affiliation: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43201, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Wood
authors.affiliation: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43201, USA.
authors.forename: C
authors.initials: C
authors.lastname: Reck
authors.affiliation: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43201, USA.
authors.forename: C
authors.initials: C
authors.lastname: Skerritt
authors.affiliation: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43201, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Levitt
mesh_terms: D001003:Anal Canal / Q000601:surgery; D000071056:Anorectal Malformations / Q000601:surgery*; D001006:Anus, Imperforate / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D012007:Rectum / Q000601:surgery
keywords: Anorectal malformation; Imperforate anus; PSARP; Pre-sacral mass; Rectal atresia; Rectal stenosis