DOES THE POSTERIOR SAGITTAL APPROACH WITH PERIRECTAL DISSECTION IMPAIR FECAL CONTINENCE IN A NORMAL RECTUM

The aim of this study was to determine, using human material and anima l experiments, whether the posterior sagittal approach with perirectal dissection (PSAPD) in patients with an intact anorectum is a suitable means of exposure far the correction of complicated anomalies of the genitourinary tract without impairment of fecal continence. Over the l ast 6 years, the authors have performed PSAPD in seven children with a n intact anorectum. At the time of operation, their ages ranged from 8 months to 14 years. All patients showed normal fecal continence at th e end of follow-up (averaging 32 months). Only after completion of the study did the authors read that Pena et al had found that PSAPD provo ked severe changes in bower control in dogs. This contradiction prompt ed the authors to repeat the animal experiments, and they could not re produce the favorable results obtained in children. This might be expl ained by the following factors: the surgical dissection used in the do gs was more extensive, anatomic differences between man and dog, the r elatively much younger age of the animals (versus the patients), and t he shorter follow-up and lack of educability of the dogs. The authors conclude that PSAPD is a suitable approach for selected lesions of the genitourinary tract in children who have a normal rectum and it does not impair fecal continence. Copyright (C) 1996 by W.B. Saunders Compa ny