Combined posterior sagittal and three-flap anoplasty in the repair of anorectal anomalies

• Published in: Journal of pediatric surgery 2001-05, Vol.36 (5), p.711-714
• Main Authors: Bass, J., Rubin, S.Z., Walton, J.M., Cada, M.
• Format: Article
• Language: English
• Subjects: Abnormalities, Multiple - surgery; anoplasty; anorectal malformations; Anus, Imperforate - complications; Anus, Imperforate - surgery; Biological and medical sciences; Fecal Incontinence - etiology; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Imperforate anus; Infant; Male; Malformations; Medical sciences; Patient Satisfaction; Rectal Fistula - complications; Rectal Fistula - surgery; Rectal Prolapse - etiology; Rectal Prolapse - prevention & control; Retrospective Studies; Single-Blind Method; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical Flaps - adverse effects; Surveys and Questionnaires; Suture Techniques; Treatment Outcome; Urethral Diseases - complications; Urethral Diseases - surgery; Urinary Bladder Fistula - complications; Urinary Bladder Fistula - surgery; Urinary Fistula - complications; Urinary Fistula - surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1053/jpsu.2001.22942

Purpose: The aim of this study was to describe a new technique for the repair of high and intermediate imperforate anus. Methods: From 1989 to 1999, 22 children with high and intermediate imperforate anus (17 boys, 5 girls) were operated on with a combination of a posterior sagittal and 3-flap perineal anoplasty. Long-term clinical follow up (to a maximum of 10 years) was done in all patients as well as a recent phone interview with a questionnaire regarding bowel function and degree of satisfaction with the result of the surgical correction. A continence ratio (CR, patient score/maximum possible score) was obtained by a blinded interviewer. Results: A continence survey was obtained in 19 patients. The average CR was 0.68. The CR for high anomalies was 0.62 and for intermediate anomalies was 0.78 (0.84 for girls and 0.64 for boys). Patients with sacral anomalies had a CR of 0.58. Two patients with Trisomy 21 had associated Hirschsprung's disease and were excluded from analysis. Conclusions: Advantages of this combined surgical approach are excellent anatomic exposure, the ability to limit rectal mobilization to a minimum, reduction of the incidence of mucosal prolapse, the new skin-lined anal canal may assist attainment of continence by providing a “sensory warning zone,” and, finally, the cosmetic appearance is satisfactory. J Pediatr Surg 36:711-714. Copyright © 2001 by W.B. Saunders Company.