The anterior sagittal trans-ano-rectal approach (ASTRA) provides excellent exposure to the urethra and vagina for partial or total urogenital sinus mobilization and subsequent reconstruction for patients with urogenital sinus anomalies. It is a frequent approach to reconstruction for children with a high confluence. However, the division of the anterior anal external sphincter and the rectal wall in the ASTRA incurs morbidity, which include fecal incontinence if one veers from the midline, and increased risk of wound infection due to fecal soilage. We demonstrate a modified technique to the ASTRA without dividing the anterior anal sphincter and rectal wall, with achievement of comparable exposure and excellent vaginal mobilization and length.
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- Anterior sagittal approach without splitting the rectal wall.Int J Surg Case Rep. 2013; 4: 723-726
Published online: December 21, 2021
Accepted: December 15, 2021
Received in revised form: September 25, 2021
Received: August 15, 2021
© 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.