Is posterior anal transfer a good treatment for vestibular anus?

Abstract

Eleven females who had a posterior anal transfer (PAT) for a vestibular anus were reviewed in order to: (1) assess the long-term functional success of this operation clinically; (2) evaluate the anorectal manometry profile; and (3) assess defaecation by video proctography. The cosmetic appearance was excellent in all patients. Seven had a good result, 2 a fair result, and 2 a poor result when assessed clinically (Kelly score) in terms of constipation and soiling. The anorectal manometry profile remained within normal limits except in the 2 with a poor result who had diminished sensory awareness of stool in the rectum. PAT does not appear to damage the muscle-sphincter complex, and the children with a large rectum full of faeces seemed to behave like children with acquired megacolon and constipation. Video proctography showed normal defaecatory patterns in all patients. Patient selection is important for this procedure. When PAT was used as the initial treatment a good result was obtained; when it was used to relieve constipation following previous surgery the result was less satisfactory.