Continence in patients who undergo posterior rectal flap anorectoplasty

Purpose: The authors report the postoperative follow-up results of patients who underwent posterior rectal flap anorectoplasty (PRFA), with emphasis i n fecal continence. Variables considered on each patient were sex, presence of fistula, location of the fistula, severity of the defect during the cor rection, sacral condition, dysraphism, and age at surgery. Methods: Continence was rated using the Pena method and defecogram. The aut hors studied 20 patients (17 boys and three girls). Results: Postoperatively, normal continence was found in 18 patients. Of th e two remaining (boys), one had grade II spotting (sacrum agenesia and uret robulbar fistula) and the other had grade II staining; this patient had the most severe malformation requiring an abdominoperineal approach. All of th e defecograms showed complete emptying of the rectum. No recurrent fistulas ocurred. Conclusions:The posterior rectal flap anorectoplasty is a new technique tha t takes into consideration all known factors that contribute to continence. This initial report confirms that this technique results in excellent cont inence for patients with imperforate anus. J Pediatr Surg 33:1760-7764. Cop yright (C) 1998 by W.B. Saunders Company.