Intraoperative Sonographic Guided Pull-through Anorectoplasty: A Novel Procedure for Imperforate Anus and Rectourethral Fistula: A Clinical Trial Study

Background: optimal surgical management of the neonate with imperforate anus (ia) depends on determining accurate location of sphincter muscle complex, pouch of rectum and rectourinary fistula. we aimed to investigate a novel minimally invasive technique of anorectoplasty assisted by intraoperative sonography pull-through for repair of anorectal malformation and rectourinary fistula. materials and methods: eight male patients with anorectal malformation and ia underwent formation of a diverting colostomy within 48 hours after birth. these patients had anorectoplasty about 6-8 weeks postoperatively. a urinary catheter was inserted per urethra into the bladder and sonography of perineum was carried out under general anesthesia. the neoanus was reconstructed by suturing the pulled-through anorectum to the anal sphincter muscle complex and the skin using absorbable 4/0 sutures. results: in all cases, the distance of pouch of rectum to the skin was 15-18 mm and entrance of the guide wire to fistula was 6-7 mm. of eight patients 6 had removal of urinary catheter after two days, and 2 patients after 10 days because the fistula was not closed. the median range of hospital stay was 2.12 days and follow- up was 30 days. we calibrate all of patients with size 12f dilators. patients were followed up at one week and one month postoperatively, and all had defecation frequency of 3-5 times a day. there were no complications. conclusion intra-operative sonography guided pulled-through anorectoplasty (ispa) is a novel and safe technique for surgical treatment of ia and rectourethral fistula. ispa is a minimally invasive approach, which preserves the external anal sphincter muscle complex with good functional outcome.