ASARP

Dr. Amit Goel, M.B.B.S.

Department of surgery, GMCH,
Aurangabad

Dr.Vivek Gharpure, M.Ch.

Children’s surgical hospital
Aurangabd
 ASARP
• Single stage ASARP is the most
popular procedure for correction of
translevator anorectal malformations
in girls
• The procedure can be carried out on
small girls and without blood
transfusions, extensive bowel
preparation or metrogyl

Asarp/amit
 ASARP demography
N= 94 girls
Age 3 months to 16 years
From 1991 to 2004
In Department of Surgery,Government
Medical College and Hospital Aurangabad
and

Children’s Surgical Hospital Aurangabad

All procedures done by a single surgeon

Asarp/amit
 ASARP selection criteria

Weight > 5 kg
1. Anus > 8 hagar
2. Rectum not dilated
3. Good bowel preparation
4. Hb >12 g
5. Assured postoperative dilatation

Asarp/amit
 ASARP preparation
Bowel preparation with 20% mannitol 6
ml/kg; given 4 hours prior to surgery
1. Surgery deferred if bowel preparation
inadequate
2. No special diet
3. No oral antibiotics

Asarp/amit
 ASARP pre-procedure
intervention
Preoperative cutback done in 35 girls
All dilated at home till anus > 8 hagar

Asarp/amit
 ASARP operative steps
1. Local infiltration between vagina and
anus for separation
2. Anus dissected all around and
separated till it is possible to reach
the perineum
3. All muscles around anal canal
carefully dissected.
4. Vaginal injuries avoided
 ASARP operative steps
1. Dissection continued upto level of
cervix/levator ani
2. Plane of dissection close to rectum
3. Tunnel made from the rectal plane to
perineal site and dilated
4. Sometimes, all tissues divided in
midline and mobilized bowel brought
posteriorly.
 ASARP operative steps
1. Nixon flaps
2. Perineal body reconstruction over #9
hagar dilator in the rectum to
prevent narrowing

Asarp/amit
PRE POST

Asarp/amit
 ASARP-Postoperative care
Cephalosporin and aminoglycoside
1. No metrogyl
2. NBM for 24hours then water
3. Milk after 48 hours
4. Urethral catheter for 48 hours
5. Laxatives after 24 hours

Asarp/amit
 ASARP- postoperative care
1. Anal dilatations commenced at 21
days and continued for one year
2. Oral laxatives tapered off over next
few weeks
3. Bulk forming agents continued for
few weeks
4. Enema administered as and when
required to prevent fecal impaction

Asarp/amit
 ASARP results n= 94
Infection 5 6% No additional treatment

Dehiscence 2 2% Repeat surgery

Stenosis 4 4.5 Dilatation/sphincterotomy/s

% kin level Z plasty
Mucosal 0 0
prolapse
Stricture

Hemorrhage 0 0

Asarp/amit
 ASARP results n=94
Constipation/fecal 6 7% Saline washouts
impaction

Fistula 0 0 0

Long term
Anterior migration 3 3.3 Barrington’s
% procedure
Incontinence 1 1 Sacral agenesis

Asarp/amit
ASARP Associated anomalies
n=94

Septate vagina 3
Double vagina 2
Sacral agenesis 1
Puj obstruction 1
Uvj obstruction 1
Short colon 1

Asarp/amit
 ASARP n=94
1.procedure can be done in one stage
without additional risk or
complications (21/94; 5/94 additional
procedure)
2. Cosmetically good for girls as
abdominal scar is avoided
3. Blood transfusions rarely required
4. Metrogyl can be avoided
5. Nixon’s flaps give skin lined anus
Asarp/amit
 ASARP
6. Early surgery helps the girl achieve
continence and normal bowel habits
7. Regular dilatation for one year keeps
the anus patent and also acts as a
stimulus for evacuation

Asarp/amit
 ASARP

THANK YOU!
Dr. Amit Goel
Dr.Vivek Gharpure
Asarp/amit