Abstract
Twenty-five cases of high anorectal anomalies were treated by a modified transrectal pull-through operation. All patients underwent diverting colostomy before definitive surgery, through which a balloon was passed into the blind rectal pouch. EMG studies were done at the site of the external sphincter in response to gradual inflation of the balloon. There was typical behavior both before and after surgery, except in two cases with sacral anomalies. These findings indicate the importance of a sensitive mucosa in the rectal pouch and of a functioning external sphincter. A modification of the pull-through technique in which a window of intact mucosa is left in situ to preserve sensation was employed in five cases and is expected to provide improved continence.
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