Posterior Sagittal Anorectaplasty-Female Part II: Pediatric Colorectal...

Sigmoid colon pulled down to function as a rectum does not have the same storage qualities and physiologic properties as native rectum.

In Don's personal series of 8 patients with rectovesical fistula and no vagina, only one turned out to have an imperforate hymen; none of the others had a uterus or fallopian tubes.

The areolar plane between rectum and urethra is much thicker when there is no vagina in between.

If you see fat during rectal mobilization, you can dissect closer to the bowel wall; if you see vessels, you are on the correct plane.

For congenital cervical agenesis, there is no evidence that retaining the uterus and connecting it to the vagina is helpful; there have been no successful live births, and the problem has been pyometra and ascending infection.

A uterus with no cervix has no value for reproduction and poses a risk of pyometra if connected to an outflow tract.

Ovaries should be preserved in patients with müllerian anomalies because there is no evidence they are a problem.

In the absence of a cervix, creating an outflow tract from the uterus is not beneficial for reproduction and sets the patient at risk for pyometra.

The ideal time to construct a neovagina is when the rectum has been mobilized; delaying would result in a scarred perineum that is technically more difficult.

Staples should not be left on any anastomosis involving the neovagina; if a stapler is used, the staple line must be removed.

If a uterine remnant without a cervix causes trouble later, it can be removed laparoscopically.

The surgeon identified tactile feedback suggesting a cervix: forceps placed on the back of the uterus could not pass through, and there was a firmness suggesting an upper vaginal lumen.