Abstract
Previously, patients commonly had fecal incontinence following repair of intermediate & high imperforate anus. Using a posterior sagittal approach, deVries & Pena have modified previous techniques by pulling the bowel within the puborectalis & external sphincter under direct vision so as to preserve these structures.
This study reports the functional results in 7 patients ( 4 males; 3 females) who have had this surgery for high (6)/intermediate (1) imperforate anus. Their mean age is 3.5 yrs. (range: 3.0 - 4.3 yrs); the mean age of anorectoplasty was 1.2 yrs. (range: .9 - 1.6 yrs). 2/7 patients are continent, 4 have control with intermittent incontinence, and 1 has a colostomy. Rectal manometry revealed basal and maximal anal canal pressures in the 2 continent patients to be normal to high and below normal in the rest. Normal rectoanal reflexes and sensation of rectal distention was present in 5 of 7, independent of continence. Defograms revealed prominent posterior shelf of the puborectalis in all but 1 case who had incontinence.
Conclusions: 1) preservation of the puborectalis and external sphincter reduces fecal incontinence following high and intermediate imperforate anus repair. 2) Normal to high basal and maximal anal canal pressure appear to correlate with fecal continence.
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Cox, K., Cannon, R. & Devries, P. FUNCTIONAL RESULTS OF POSTERIOR SAGITTAL ANORECTOPLASTY FOR INTERMEDIATE AND HIGH IMPERFORATE ANUS. Pediatr Res 18 (Suppl 4), 194 (1984). https://doi.org/10.1203/00006450-198404001-00607
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DOI: https://doi.org/10.1203/00006450-198404001-00607