The posterior sagittal approach, first performed for a child with imperforate anus in 1980 revolutionized the care of children with this problem as it provided unique exposure to the pelvis. It is used now in the management of patients with congenitalanorectal malformations including imperforate anus and cloacal malformations. In addition, the approach has been applied to other pelvic problems, such as urethral strictures, presacral masses, and acquired rectovaginal fistulae. The key principles of the posterior sagittal approach are that it provides excellent exposure to the pelvis, with improved visualization from previous techniques, minimizing complications. It has applications to a variety of pelvic problems, that are too low to reach via the abdomen and too high to reach via a transanal only approach.
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