الفهرس 
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Abstract
Background: In 1982, deVries and Pena stated that the external anal sphincter that was always described as being rudimentary, exists with various degrees of development and that it should always be utilized to achieve better continence. Using the posterior sagittal approach, a muscle stimulator and dividing these muscles strictly in the midline; one can place the rectum within the boundaries of the sphincteric mechanism under direct vision, and repair meticulously these structures. Aim of work: To evaluate the posterior sagittal anorectoplasty as a technique for repair of congenital anorectal malformations. Methods: This work presents the management of fifty eight patients with congenital anorectal anomalies by the posterior sagittal approach (PSARP) at the Pediatric Surgery Unit, Mansoura University Children Hospital and the Pediatric Surgery Department, Ospedale Riuniti di Bergamo, Bergomo, Italy during the period from April 1999 to May 2003. 32 male and 26 female patients were included in the study. Thirty nine patients needed a diverting colostomy prior to the rectal reconstruction. Results: A colostomy with two separate stomas was obviously superior to any other form of colostomy. A colostomy should always be considered as being a more major operation, because faults in fashioning it would cause problems that might be difficult to deal with. In the vestibular fistula, colostomy may be regarded as a high price for reconstruction. This anomaly can be repaired without a colostomy only if the bowel is properly prepared preoperatively for 2-3 days, and the patient kept on a low residue diet for a while postoperatively. Abdominal ultrasonography proved to be very useful to screen these patients for associated anomalies. However, a ”distal colostogram” should always be considered prior to any reconstruction. Anorectal manometry and MRI were helpful in assessing the position of the rectum and the condition of the pelvic muscles. 74% of our patients were considered totally continent, the incontinent part of our patients were subjected to the bowel management program. Conclusion: The posterior sagittal approach offers good exposure of the anatomy of the area and utilizes all the muscular factors present in the infant to give a good potential for continence.