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The lower part of the muscle complex was retracted down to expose the posterior wall of the rectum.
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The muscle complex was identified and its lower part was retracted downward to expose the posterior wall of the rectum ( Fig. 1 ).
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Anatomy of the patient.
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The rectum, which was abnormally dilated until 1 to 2 cm beyond the peritoneal reflection, continued as sigmoid colon whose caliber appeared suddenly normal ( Fig. 2 ).
Sigmoid colon surgically separated from the dilated rectum.
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Mobilized sigmoid colon passed into the posterior sagittal space.
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The center of the sphincter complex is defined using a neurostimulator.
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Once the suprapubic incision was sutured and the patient was again in the same prone position as before, a second small inverted cutaneous Y-shape incision was made on the anal dimple, after reconfirming the location of the underlying anal muscle complex using the neurostimulator ( Fig. 5 ).
Progressive dilation of the tunnel created in the center of the sphincter complex.
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Our technique was different from the original technique of PSARP described by Pena and Devries, which envisages to separate the sphincter muscle complex in the midline.  In contrast, we created a tunnel in the center of the sphincter muscle complex through a gentle and progressive dilation of its muscle fibers using Hegar dilators (size 6-12) ( Fig. 6 ) until reaching an acceptable diameter to enable the mobilized sigmoid colon to go through it. 
The sigmoid colon is passed through the dilated tunnel of the sphincter complex and a neoanus is created.
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 Consequently, the sigmoid colon, that managed to pass through the dilated tunnel of the sphincter muscle complex, was sutured to the external sphincter and to the margins of the small Y-shape cutaneous incision that had already been made in the anal dimple by using interrupted absorbable stitches ( Fig. 7 ).The posterior sagittal incision was then closed.
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Neoanus and neovaginal introitus at 2.6 years of age.
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The rectovestibular fistula, that had become the vagina introitus, appeared relatively wide and easily to explore ( Fig. 8 ).