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a clinical pearl PSARP vs Lap assisted PSARP
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Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -
"A useful rule to assist the surgeon on whether or not a laparoscopic approach can be taken is to draw a line from the tip of the coccyx to the very next structure one would find via a posterior sagittal approach. If the structure which the line touches on the contrast enema is the rectum, then the rectum is reachable from below. If that structure which the line touches is the bladder, urethra, or vagina, then laparoscopy will be needed in order to dissect the rectum intra-abdominally (Fig. 43.1a, b)."
"A useful rule to assist the surgeon on whether or not a laparoscopic approach can be taken is to draw a line from the tip of the coccyx to the very next structure one would find via a posterior sagittal approach. If the structure which the line touches on the contrast enema is the rectum, then the rectum is reachable from below. If that structure which the line touches is the bladder, urethra, or vagina, then laparoscopy will be needed in order to dissect the rectum intra-abdominally (Fig. 43.1a, b)."
Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay -
"Careful selection of the approach on anorectal malformations reconstruction cannot be stressed enough. A purely posterior sagittal approach only in those patients with high rectum can pose dangerous. First, the dissection travels deep into the pelvis often requiring a coccygectomy in order to reach the peritoneal reflection. Second, if the rectum in high, the bladder can be easily confused with the rectum and leading to misidentification and injury to the urinary tract."
"Careful selection of the approach on anorectal malformations reconstruction cannot be stressed enough. A purely posterior sagittal approach only in those patients with high rectum can pose dangerous. First, the dissection travels deep into the pelvis often requiring a coccygectomy in order to reach the peritoneal reflection. Second, if the rectum in high, the bladder can be easily confused with the rectum and leading to misidentification and injury to the urinary tract."