ANTERIOR SAGITTAL TRANSANORECTAL APPROACH TO THE UROGENITAL SINUS IN ADRENOGENITAL SYNDROME - PRELIMINARY-REPORT

In the female adrenogenital syndrome. the treatment of the urogenital sinus with high implanted vagina still presents a surgical challenge. The conventional technique (perineal vaginal pull-through) has been pl agued by a high incidence of vaginal stenosis. A posterior sagittal tr ansanorectal approach was proposed as an alternative to obtain an exce llent exposure and thus an adequate mobilization of the vagina. But bi valving a normal rectum and anus has the potential for compromising bo wel control and represents a bold maneuver. and the rectum and sphinct eric mechanism must be meticulously reconstructed. In the original pro cedure a protective colostomy must be performed before the operation. To reduce these disadvantages, the authors made the following modifica tions: sagittal incision of only the anterior rectal wall (Anterior Sa gittal Transanorectal Approach-ASTRA) and protective colostomy at the same time as the operation. In this way, maintaining the same excellen t exposure and reducing the number of operations from three to two, we operated on 10 girls with adrenogenital syndrome: 4 with high, 3 with intermediate urogenital sinus, and 3 who had previously undergone vag inal pull-through but experienced a vaginal retraction with severe ste nosis. At the time of surgery four patients were under 1 year (mean, 9 .25 months) and six were from 2 to 11 years of age (mean, 6.5 years). After closing the colostomy, all patients were continent in stools and urine, and the vagina looked normal. The authors suggest using this m odified approach as an alternative to the conventional operation and f or those patients in whom other techniques have failed. Copyright (C) 1997 by W.B. Saunders Company.