Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Rectal Prolapse Repair Following a Posterior Sagittal Anorectoplasty
4 min · Published Jan 2025
Video
Laparoscopic Assisted Posterior Sagittal Anorectoplasty
5 min · Published Jan 2025
Video
Posterior Sagittal Anorectoplasty
6 min · Published Mar 2025
Video
Colorectal Quiz: Episode 41 - Perineal Hypospadias
Marc Levitt · 17 min · Published Nov 2024
Podcast
Anorectal Malformations Complications
Marc Levitt · 48 min · Published Feb 2016
Podcast
Colorectal Quiz Episode 2: When to redo a PSARP
18 min · Published Jan 2021
Video
Validation of an anorectal malformation trainer - Can a high-fidelity model simulate real life?
1 min · Published Jun 2026
Video
Complications and Long-Term Outcomes of Patients With Cloacal Malformation After Bowel Neovagina...
1 min · Published Jun 2026
Video
Safety and utility of long-acting steroid injection for management of post-operative stricture...
1 min · Published Jun 2026
Video
Association Between Social Determinants of Health and Choice of Urinary Reconstruction in Children
1 min · Published Jun 2026
Video
The Perineal Body Preserving PSARP (PPP)
11 min · Published Jun 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Colorectal Quiz Ep. 50 -16th Annual European Pediatric Colorectal & Pelvic Reconstruction Conference
Marc Levitt · Published Mar 2026
Podcast
Colorectal Quiz: Episode 50 - 16th Annual European Pediatric Colorectal and Pelvic Reconstruction Conference, Stockholm, Sweden, October 2025 - What did we learn?
24 min · Published Mar 2026
Video
Colorectal Quiz Episode 33: Cloaca Exstrophy
Marc Levitt · 22 min · Published Sep 2025
Video
The Colorectal Quiz Episode 21: The History of Hirschsprung Disease
Marc Levitt · 15 min · Published Sep 2025
Video
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Care (with Help from AI)
Marc Levitt · 40 min · Published Jul 2025
Podcast
Colorectal Quiz: Episode 49 - Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
Marc Levitt · 40 min · Published Jul 2025
Podcast
Long-term obstetric and gynecologic care for patients with anorectal malformations
21 min · Published Sep 2026
Podcast
Post-pubertal gynecologic evaluation and management of patients with anorectal malformations
22 min · Published Sep 2026
Podcast
Pre-pubertal gynecologic evaluation and management of patients with anorectal malformations
23 min · Published Sep 2026
Podcast
Methods of gynecologic evaluation for patients with anorectal malformations
21 min · Published Sep 2026
Podcast
Gynecologic care in patients with anorectal malformations: A primer and call to action
18 min · Published Sep 2026
Podcast
Evaluation and Management of Postsurgical Patient With Hirschsprung Disease Neurogastroenterology & Motility Committee: Position Paper of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)
17 min · Published Sep 2026
What the experts said
A no-fistula anorectal malformation defect is managed very similarly to a bulbar urethral fistula.
The key to starting any anorectal malformation repair is a good imaging study.
Fistula levels can be classified anatomically: bladder neck fistula is at the deltoid level (C), rectoprostatic fistula is at the triceps level (B), and rectobulbar fistula is at the elbow of the urethral curve or distal (A).
It is important to mark the sphincter location before making the posterior sagittal incision because once the incision is made, it is hard to know exactly where the sphincter center is.
The sphincters must be cut perfectly in the midline so that they can be easily reconstructed.
Without a good distal colostogram, the midline whitish structure at the center of the dissection could be the urinary tract rather than the rectum.
Lateral dissection should be performed before turning attention anteriorly during rectal mobilization.
The initial anterior dissection to separate rectum from urinary tract is a submucosal dissection for the first few millimeters.
During lateral dissection, any fat seen means you can get closer to the rectum safely.
The lower the rectum is positioned, the longer is the common wall between rectum and urinary tract.
A lower rectum is easier to repair in one sense but harder because there is a longer dissection adjacent to the urethra.
A rectum at the bulbar level is too low to approach laparoscopically and is much safer to approach posterior sagittally.
Approaching a low rectum laparoscopically risks leaving behind distal rectum, a remnant of the urethral fistula, or a roof.
The rectum must be in the correct dissection plane or it will not mobilize properly.
When closing the muscle complex, taking a bite of the rectum helps to avoid prolapse.
The rectum should lie adjacent to, not constricted by, the muscle complex.
As much rectum as possible should be preserved during the repair.
The anoplasty is performed with 16 sutures under slight tension so that when stitches are cut, the rectum will gently retract and appear like a normal anus.
Dilations begin at 2 weeks postoperatively.
Colostomy closure can take place 2 to 3 months after PSARP once the anus has reached its desired size.