IS POSTERIOR ANAL TRANSFER A GOOD TREATMENT FOR VESTIBULAR ANUS

Eleven females who had a posterior anal transfer (PAT) for a vestibula r anus were reviewed in order to: (1) assess the long-term functional success of this operation clinically; (2) evaluate the anorectal manom etry profile; and (3) assess defaecation by video proctography. The co smetic appearance was excellent in all patients. Seven had a good resu lt, 2 a fair result, and 2 a poor result when assessed clinically (Kel ly score) in terms of constipation and soiling. The anorectal manometr y profile remained within normal limits except in the 2 with a poor re sult who had diminished sensory awareness of stool in the rectum. PAT does not appear to damage the muscle-sphincter complex, and the childr en with a large rectum full of faeces seemed to behave like children w ith acquired megacolon and constipation. Video proctography showed nor mal defaecatory patterns in all patients. Patient selection is importa nt for this procedure. When PAT was used as the initial treatment a go od result was obtained; when it was used to relieve constipation follo wing previous surgery the result was less satisfactory.