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

Pelvic MRI in infants is limited in ability to delineate small structures like uterus and ovaries

The anesthesia nerve stimulator (train-of-four box) with standard probes is a less expensive alternative to dedicated pelvic floor stimulators

Lateral dissection defines the anterior plane in posterior sagittal anorectoplasty

In absent vagina cases with anorectal malformation, the urethra is characteristically enlarged

In absent vagina cases, there is typically a thick wall between the rectum and urethra

Sigmoid colon can be used for neovaginal reconstruction in absent vagina cases

Delayed neovaginal reconstruction through scar tissue from prior rectal repair will be technically challenging

Neovaginal reconstruction in absent vagina cases is typically delayed until 15-20 years of age

If patient has a uterus, vaginal reconstruction must be completed before menarche to allow menstrual drainage

Diagnostic laparoscopy is preferred over imaging to assess for upper vaginal structures and uterus in newborns with absent vagina

In absent vagina cases without uterus, the distal rectum can be used as neovagina, though this sacrifices potential continence benefit

In straightforward primary anorectal malformation cases in newborns, examination under anesthesia should be performed at the time of definitive repair rather than as a separate procedure