Posterior sagittal approach: Megasigmoid resection and anal reconstructionfor severe constipation and fecal incontinence after anoplasty

Purpose: The aim of this study was to present the technique of megasigmoid resection and anal reconstruction by complete posterior sagittal approach f or the children with severe constipation and fecal incontinence after anopl asty. Methods: Six patients (age, 2 to 18 years) born with imperforate anus and o riginally treated with perineal anoplasty suffered from intractable constip ation and fecal incontinence. Contrast enema showed massive dilated and ape ristaltic rectosigmoid colon with fecal impaction. Resection of the dilated bowel and anal reconstruction were completely performed by posterior sagit tal approach. Results:The mean operating time was 205 minutes (range, 125 to 265 minutes) and the average length of resected colon was 23.3 cm (range, 10 to 40 cm). There were no intraoperative or postoperative complications. By 2 to 4 mon ths after the operation, all patients obtained voluntary bowel movement. On follow-up at 6 to 24 months postoperative, no patient had constipation or required use of the laxatives again. Four of 6 patients suffered from grade 1 soiling, and the other 2 had grade greater than 1 soiling. None had urin ary retention or incontinence after the procedure. Conclusion: Resection of dilated rectosigmoid colon and anal reconstruction for the patients with severe constipation and fecal incontinence after ano plasty can be performed successfully using a posterior sagittal approach. C opyright (C) 2000 by W.B. Saunders Company.