Rectal Atresia: Multiple Approaches in Neonates

Aim: The aim of this study is to present multiple approaches in management of rectal atresia in neonates and to discuss the outcome of each approach.Patients and Methods: Between 2002 to 2010, a prospective study of 15 patients with rectal atresia; they were treated at Pediatric Surgical unit at Children University Hospital. They were segregated into three groups according to surgical approach that was carried out. First group (five neonates) was subjected to three-stage procedures. Second group (five neonates) was subjected to neonatal transanal end-to-end rectorectal anastomosis. Third group (five neonates) was subjected to neonatal mini PSARP.Results: All children were presented with rectal atresia. Their age was ranged from one to five days. The male to female ratio was 7 to 8. 13 out of them were full term with normal vaginal delivery. The remaining 2 patients were preterm. Three out of 15 patients had other anomalies. Intraoperative complications were nil in three groups. Second and third groups had less hospital stay. Two patients developed wound infection in first group. Anal stenosis occurred in one patient of second group. One patient developed fecal discharge from 3rd group and treated conservatively. All patients were subjected to postoperative follow-up program for at least six months. The parents of the second and third groups were satisfied regarding one stage procedure in addition to fecal continence of their infants.Conclusion: Many approaches could be carried out for surgical management of rectal atresia. Neonatal approaches could be applied easily and safely, with less cost-effect. Mini PSARP is considered a less traumatizing procedure to anal sphincter with easy anastomosis that was carried out under vision.