I got my new bum

PSARP – Posterior Sagittal Anorectoplasty (Pull-Through Surgery) – Operation 2

The PSARP was developed by the legendary Alberto Peña in 1980. It remains the gold standard surgical technique for correcting anorectal malformations.

Iz’s surgeon, the incredible Mr Eradi at Leicester Royal Infirmary, was trained in this very technique by Dr Peña himself. That gave me an enormous amount of comfort. Handing your child over for surgery is agonising — there is no other word for it — but trusting the person you’re handing them to makes all the difference.

Mr Eradi is quiet and unassuming. But that man — let me tell you — is exactly who you want operating on your child. Calm. Composed. Exceptionally skilled. The quiet exterior hides remarkable ability. I don’t even know how you thank someone who has given you everything.

The Day of Surgery

We had to arrive at 10am. As with all operations, there was a pre-op phone call a few days before to go through the details — when to stop feeds (milk, in Iz’s case), what to expect, timings.

We arrived, waited for a bed, and once you’re taken to that bed… you know it’s happening.

Iz was amazing. She couldn’t have milk from around 6am and went down to theatre at about 2pm. We joked that if this had been our son, he’d have screamed the hospital down over that length of time without milk.

The surgery lasted around three and a half hours.

When I was called to recovery (resus) because she wasn’t happy — obviously — it was a shock.

For the operation, Iz had been positioned on her front. After 3.5 hours face-down, her little face was very swollen. She was hoarse from the anaesthetic. She was attached to wires. She had just had an incision made from half an inch above her bum crack down towards her vagina. Of course she was upset.

Seeing her was both overwhelming relief and absolute agony. Relief that she was there. Agony that she was distressed.

But that wasn’t a moment to fall apart. That was a grit-your-teeth and be-Mumma moment. And that’s what I did.

I phoned an anxiously waiting Daddy from recovery to tell him she was awake and okay. Once back on the ward and after some milk, the swelling started to settle.

The Epidural That Didn’t Work

Iz’s epidural unfortunately didn’t work, so they had to adjust her anaesthesia plan. Epidurals are usually ideal for this type of surgery, especially in little ones, as they provide excellent pain control close to the wound site and reduce movement.

That said, her anaesthetist — the same lovely lady who cared for her during her first surgery — was someone I trusted deeply. In some of the darkest hours of my life, she gave me reassurance. I knew Iz was safe with her.

The Pillow Trick (A Lifesaver)

A nurse gave us a tip that was pure magic: use a pillow.

I’d brought a huge muslin cloth. We placed Iz on the pillow, wrapped the muslin around her (under her arms and around the pillow), and used that to manoeuvre her.

We could lift her, reposition her, and even rotate her for examinations simply by turning the pillow. No pressure on her beautiful little “designer” bottom.

For nappy changes, we slid a puppy pad under her on top of the pillow. It made everything so much easier.

If you’re reading this ahead of a PSARP — take a pillow – they gave us one.

The First Night

The first night was tough. Her pain relief wasn’t quite right initially, so her morphine was increased and she settled.

What amazed me most was how quickly she came off everything. Within a short time she was down to plain old paracetamol. I was honestly astonished at how fast she recovered.

Children are extraordinary. Iz is extraordinary.

Wound Care – The Honest Version

I’m going to be very honest here, because I wish someone had been with me.

We were given:

Antibiotic eye cream
Saline ampoules
Dry wipes (no baby wipes allowed)
Gloves

We were told: rinse with saline, dab dry, apply eye cream. Once that ran out, move onto barrier cream.

The wound was mostly glued, with some stitches. The first time I opened her nappy, I was scared of what I’d see. It wasn’t as bad as I had imagined — but it was still difficult.

Cleaning was scary at first. You don’t want to hurt them. And yes, it did hurt.

Thankfully, it was mostly urine at this stage. A good squirt of saline, very gentle dabbing, then carefully applying the cream with gloved hands.

What shocked me most was realising the incision went further than I had mentally prepared for — up to about half an inch above her bum crack. I don’t know why that surprised me, but it did. The thought of her being opened and repaired like that still makes me wince.

There were a few moments where I worried the wound was splitting. In hindsight, it was probably just the surgical glue (which looks a lot like skin), but when you’re unsure — ask. Her surgical team never minded checking. They reassured me every time.

Always ask if you’re worried.

A Difficult Final Night in Hospital

Our last night was stressful.

The child in the next bed had a gastro bug. His father, who was staying with him, also had it. They had multiple visitors, including a two-year-old sibling who repeatedly wandered toward Iz’s space – wanting to see the baby… the baby being Iz. I overheard them explaining that the whole family had been unwell and Iz getting a gastro bug would have been a disaster in her position at that point.

If you are ever visiting someone in hospital — please, please do not enter another patient’s cubicle.

Hospitals are full of vulnerable people. Parents like us have spent months obsessing over germs to get our children safely to surgery. Carelessness is terrifying when you’re in that position.

I didn’t make eye contact. I didn’t smile. I made it very clear without words. Thankfully, the mother took the hint.

I’m not confrontational. But I would have been.

Getting Home

I was nervous about the car journey — her sitting on her bottom in the car seat — but she was absolutely fine.

We got home. She slept.

Then in the middle of the night, I woke up unwell. I panicked, assuming it was the gastro bug. I phoned the ward to alert them and ask what to do if Iz became sick. Their advice was simple: if she develops symptoms, bring her in.

It turned out to likely be food poisoning — a massive coincidence as I was the only one who got it thankfully.

I stayed away from her overnight and the next day. Gloves. Mask. Extreme hygiene. Daddy held the fort beautifully.

She never caught it.

Healing at Home

Within a couple of days she was off all medication.

When the eye cream ran out, I chose Bepanthen as her next cream — purely because the consistency was similar. That was the extent of my scientific reasoning.

It worked. Her bottom healed beautifully.

We did have one small scare when some poop appeared. I was initially thrilled — “Her new bum works!” — before realising anatomically that didn’t make sense yet.

I phoned the ward and spoke to our favourite nurse. Completely normal, she said. It was just old meconium from birth finally making its way out.

And that was that.

If you’re reading this before your child’s PSARP:

It is frightening. It is overwhelming.

But they are stronger than you can imagine.

And so are you. 💛