Posterior sagittal anorectoplasty for failed imperforate anus surgery: Lessons learned from secondary repairs

Purpose: The aim of this study was to evaluate secondary operations using a posterior sagittal approach in patients with fecal incontinence and impact ion after primary repair of anorectal malformations. Methods: Twenty patients (14 boys, 6 girls) who had previous failed surgery for imperforate anus underwent secondary operations. The indications for s urgery included fecal incontinence (n = 16) and fecal impaction (n = 4). Pa tients ranged in age from 2 to 30 years (mean, 11 years), with 4 over the a ge of 20 years. The primary procedures included abdominosacroperineal (n = 7), sacroperineal (n = 10), and perineal (n = 3) pull-throughs. At surgery, none of the patients underwent a diverting colostomy. The rectum was mobil ized from the surrounding structures through a posterior sagittal approach. The surgical findings included anteriorly displaced anus (n = 17), lateral ly displaced anus (n = 3), mesenteric fat surrounding the rectum (n = 4), m ega-rectosigmoid (n = 2), and others (n = 3). The rectum underwent reconstr uction, which involved relocation of the rectum and anus to surround them w ith the muscle complex. Results: Patients underwent follow-up for periods ranging from 8 months to 6 years after surgery (mean, 3 years). To evaluate the functional results, fecal continence scores (Templeton and Ditesheim) were calculated for incon tinent patients. Of the 16 incontinent patients, 12 achieved continence and 4 some improvement. Of the 4 patients with fecal impaction, 2 achieved dai ly voluntary bowel movement, whereas the other 2 have mild constipation and need occasional enemas. Conclusions: Our study suggests that (1) a secondary operation through a po sterior sagittal approach can restore fecal continence and is efficacious e ven in adolescents and adults and (2) a posterior sagittal procedure can be safely performed without a diverting colostomy. Copyright (C) 2000 by W.B. Saunders Company.