Rectal Prolapse Repair Following a Posterior Sagittal Anorectoplasty

Rectal prolapse repair after a posterior sagittal anorectoplasty. We present a case of a very common problem following repair of an anorectal malformation, a rectal prolapse. Rectal prolapse is a problem as it can cause mucus production and bleeding and it can also interfere with the patient's ability to close the anus and thereby affect their bowel control. In this case you see a unilateral rectal prolapse on the patient's left side, one year after a posterior sagittal anorectoplasty. We check the anoplasty location first with the electrical stimulator and note that it is well located with circumferential contractions. We begin by placing silk sutures at the mucocutaneous junction. And now we separate the silks into an upper and lower quadrant. We incise full thickness rectum off of the skin edge preserving the sphincter muscle. Because we have left the right side of the anoplasty untouched, this should reduce the risk of a postoperative stricter. The rectum is mobilized out until there is slight tension and the intended cut line will comfortably reach the anal skin. These extra stitches go into the redundancy and help straighten out the rectal tissue prior to incising it. The loan star retractor is very helpful to set up the anoplasty. We now begin the anoplasty taking a bite of anal skin to full thickness rectal wall. We now divide the upper and lower quadrants of the left-sided prolapse which creates two triangles. We now begin the anoplasty taking a bite of anal skin. And we transact the triangles and continue suturing rectal wall to anal skin. We now begin the anoplasty taking a bite of anal skin to full thickness rectal wall. And we begin the anoplasty taking a bite of anal skin. We now begin the anoplasty taking a bite of anal skin. All sutures are tied under slight tension so that once cut the anoplasty retracts back nicely. All sutures are tied under slight tension so that once cut the anoplasty retracts back