Looking for a rectum without evidence that the rectum is there is the main source of complications in this approach. The urethra, vas deferens, prostate, and seminal vesicles will be found there and this will damage the nerves important for urinary control and sexual potency.
The posterior rectal wall is easily identified by it has a whitish appearance. The surgeon should keep in mind that there is a fascia that covers the rectum posterior and laterally that must be removed.
The dissection of the rectum must be performed staying as close as possible to the rectal wall without injuring the rectal wall itself. The posterior rectal wall is opened in the midline, in between two 5/0 silk stitches. The incision is continued distally, staying in …show more content…
The perineal body is reconstructed when the incision extends anterior to the center of the sphincter. The anterior limits of the sphincter must be reconstructed. The posterior edge of the levator muscle is electrically determined, and the rectum is placed in front of the levator. The posterior edges of the levator muscle are sutured together with interrupted 5/0 long-term absorbable sutures. The distal continuation of the levator muscle is arbitrarily called the muscle complex. The posterior edge of this muscle structure is sutured together in the midline with interrupted 5/0 long-term absorbable sutures. These sutures also take a bite of the posterior rectal wall in order to anchor the rectum in a good position to avoid retraction and/or …show more content…
The advent of minimally invasive procedures has been extended to anorectal malformations and doctors believe that it has specific indications in those patients that formerly required a laparotomy and still do no proof that the laparoscopic repair of a Rectourethral fistula is less invasive than the posterior sagittal approach alone. However, in a case of Rectobladder neck fistula, the rectum can be separated from the urinary tract laparoscopically avoiding a laparotomy. These patients do not have a good functional prognosis. Only few percentages will have voluntary bowel movements by the age of 3. These patients require a posterior sagittal approach to create the space through which the rectum will be pulled down. During the laparotomy or laparoscopy, the rectum must be separated from the urinary tract. In these very high malformations, the common wall between the rectum and the urinary tract is very short. In other words, the rectum connects to the bladder neck in a “T”