THE FAILED ANOPLASTY - SUCCESSFUL OUTCOME AFTER REOPERATIVE ANOPLASTYAND SIGMOID RESECTION

Background/Purpose: Children with anorectal malformations often have l ess than optimal results after repair. The authors report on five pati ents (ages 3 to 17 years) born with imperforate anus and treated with anoplasty as a newborn. At presentation, all patients were completely incontinent of stool. None had ever experienced voluntary bowel moveme nts, and all wore diapers continuously. Methods: Perineal examination with the nerve stimulator showed the muscle complex was largely intact with good contraction, but the neoanus was outside of the muscle comp lex. Contrast enema showed massive dilation of the rectosigmoid colon and fecal impaction. A tethered spinal cord was excluded by magnetic r esonance imaging (MRI). We treated these patients with a combined reop erative anoplasty via the posterior sagittal approach and sigmoid rese ction. Results: Within 6 months after the procedure, all patients had achieved complete continence. They had from one to th ree voluntary bo wel movements per day without soiling. Conclusions: Children with seve re constipation and fecal incontinence after anoplasty should undergo evaluation by a surgeon. if examination shows a reasonably intact musc le complex and correctable anatomic defects, an excellent result can b e achieved with appropriate reoperation. J Pediatr Surg 33: 1145-1148. Copyright (C) 1998 by W.B. Saunders Company.