Posterior sagittal anorectoplasty in adults - Secondary repair for persistent incontinence in patients with anorectal malformations

PURPOSE: Posterior sagittal anorectoplasty, regarded as a standard surgical primary repair for anorectal malformations in infancy, was evaluated for e ffectiveness when performed as a secondary operation for establishing conti nence in the adult. The purpose of this review was to evaluate our results of performing posterior sagittal anorectoplasty in adult patients and to em phasize the extensive evaluation required to perform proper patient selecti on. METHOD: From January 1, 1992, to December 31, 1996, eight patients with Grade 3 incontinence underwent posterior sagittal anorectoplasty. The ages ranged from 13 to 40 (mean, 26) years. RESULTS: All patients had diverting stomas at the time of repair and all but one had restoration of intestinal continuity. Of eight patients who underwent posterior sagittal anorectopla sty, one failed secondary to rectal ischemia and retained a diverting stoma . Six patients had restoration of continuity. Five patients were continent and one had incontinence only to gas. DISCUSSION: We have established that posterior sagittal anorectoplasty can effectively be used to establish cont inence as a secondary procedure for a select group of adult patients.