Treatment of anorectal anomalies by anterior perineal anorectoplasty

Abstract

Purpose: The aim of this study was as an introduction of a technical modification to the anterior perineal approach for the treatment of anorectal anomalies (AA) and analysis of its long-term results. Methods: Forty-three children with AA underwent a modified anterior perineal anorectoplasty (APA), which involved the following technical guidelines: construction of a rectoanal muscular conduit through the levator ani muscle and the external anal sphincter, which were sutured to each other; preservation of the rectal end of the fistula; and invagination of the perineal skin through the neoanus. Fecal continence was assessed on average 7 years postreconstruction by Kelly's score. Results: Of the 20 patients (19 boys) with high AA, results were good, fair and poor in, respectively, 50%, 30%, and 20% of them. Results were good and fair in, respectively, 79% and 21% of the 14 patients (all girls) with intermediate AA. All 9 patients (7 boys) with low AA had good results. The differences among groups were statistically significant ( P = .016). Conclusions: This modified APA allows for the surgeon to securely identify, preserve, and reconstruct all anatomic structures that are relevant for fecal continence. The longterm results of this initial series suggest that this modified APA is a valuable alternative for the treatment of AA.