Neonatal PSARP: Recalling the traditional classifications of Anorectal anomalies

Background : Primary reconstruction of anorectal anomalies without colostomy offers significant benefits, including financial and psychological relief for families. In this report, we would like to share our preliminary experience with neonatal PSARP performed without covering colostomy. Patients and methods : The study included cases of imperforate anus who underwent primary PSARP at birth without covering colostomy during the period between September 2021 and November 2024. Data prospectively retained by the author were analyzed. Preoperatively, the level of rectal termination was identified via cross table lateral x-ray films. Cases were classified as low, intermediate, or high; only cases with intermediate type were included. Results : The study included 11 cases with imperforate anus (7 boys and 4 girls) who underwent primary PSARP on their second day of life. The type of anorectal anomaly was imperforate anus without fistula in five (4 girls and a boy), while recto-urethral fistula was found in the remaining six boys. The posterior sagittal (perineal) approach was successful in identifying and mobilizing the rectal pouch in all cases, in addition to identification, separation, and ligation of associated fistula in cases of rectourethral fistula. Postoperative wound complications developed in two cases that required a salvage colostomy in one of them. Associated cardiac anomalies were detected in two cases; unfortunately, one of them died from cardiopulmonary complications. Conclusion : In the neonatal period, primary PSARP without colostomy is feasible in cases of imperforate anus without fistula as well as cases with rectourethral fistula. Objective preoperative localization of the level of rectal termination within the pelvis is a prerequisite for obtaining comparable surgical outcomes to the standard staged repair.