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. 1978 Jun;187(6):583–591. doi: 10.1097/00000658-197806000-00001

A Clinical Evaluation of the Surgical Treatment of Anorectal Malformations (Imperforate Anus)

E Ide Smith, William P Tunell, G Rainey Williams
PMCID: PMC1396454  PMID: 646498

Abstract

The surgical correction of anorectal malformations remains a serious problem despite their relatively frequent occurrence. Our surgical experience with 90 patients, seen in the past ten years, includes abdominal-perineal or sacro-abdominal-perineal repair in 28 patients, complete perineal anoplasty in 13 patients, and “cut-back” perineal anoplasty in 38 patients. Secondary surgical procedures for “fecal reservoir syndrome” (seven patients), revision for stricture (11 patients) and excision of redundant mucous membrane (ten patients). The observations made from this clinical study are: 1) The importance of thorough urological and neurological evaluation of “high” abnormalities and the value of the cremasteric and bulbocavernosus reflexes as indicators of sacral innervation. 2) Increasing satisfaction with the “cut-back” anoplasty as a definitive procedure or as a temporary stage in low recto-vaginal or recto-vestibular fistulas. The technique for the “cut-back” is improved by the use of Burow's triangles and the use of nonabsorbable sutures. 3) The advisability of the complete perineal anoplasty with posterior positioning of the anus and construction of a perineal body in patients with low recto-vaginal and recto-vestibular fistulas. 4) A concern over the functional capacity of the distal bowel segment in high abnormalities. This is emphasized by the experience with six secondary resections of the rectosigmoid or left colon for “fecal reservoir syndrome.” 5) Heartening results with secondary operations for stricture and redundant mucous membrane which suggest the desirability of an earlier surgical approach to these complications.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arhan P., Faverdin C., Devroede G., Dubois F., Coupris L., Pellerin D. Manometric assessment of continence after surgery for imperforate anus. J Pediatr Surg. 1976 Apr;11(2):157–166. doi: 10.1016/0022-3468(76)90280-3. [DOI] [PubMed] [Google Scholar]
  2. BILL A. H., Jr, JOHNSON R. J. Failure of migration of the rectal opening as the cause for most cases of imperforate anus. Surg Gynecol Obstet. 1958 Jun;106(6):643–651. [PubMed] [Google Scholar]
  3. BROWNE D. Some congenital deformities of the rectum, anus, vagina and urethra. Ann R Coll Surg Engl. 1951 Mar;8(3):173–192. [PMC free article] [PubMed] [Google Scholar]
  4. Brandesky G., Holschneider A. M. Operations for the improvement of faecal incontinence. Prog Pediatr Surg. 1976;9:105–114. [PubMed] [Google Scholar]
  5. Brent L., Stephens F. D. Primary rectal ectasia. A quantitative study of smooth muscle cells in normal and hypertrophied human bowel. Prog Pediatr Surg. 1976;9:41–62. [PubMed] [Google Scholar]
  6. Kiesewetter W. B., Chang J. H. Imperforate Anus: a five to thirty year follow-up perspective. Prog Pediatr Surg. 1977;10:111–120. [PubMed] [Google Scholar]
  7. NILOFF P. H., GELFAND M. M., STREAN G. J. Imperforate anus with rectovaginal fistula in an adult. Can J Surg. 1960 Apr;3:248–251. [PubMed] [Google Scholar]
  8. Nixon H. H., Puri P. The results of treatment of anorectal anomalies: a thirteen to twenty year follow-up. J Pediatr Surg. 1977 Feb;12(1):27–37. doi: 10.1016/0022-3468(77)90292-5. [DOI] [PubMed] [Google Scholar]
  9. PARKKULAINEN K. V., HJELT L., SULAMAA M. Anal atresia combined with aganlionic megacolon. Acta Chir Scand. 1960 Jan 30;118:252–256. [PubMed] [Google Scholar]
  10. SOMMERSCHILD H., KNUTRUD O., FRETHEIM B. ANORECTAL ANOMALIES. Acta Chir Scand. 1964 May;127:536–542. [PubMed] [Google Scholar]
  11. Santulli T. V., Kiesewetter W. B., Bill A. H., Jr Anorectal anomalies: a suggested international classification. J Pediatr Surg. 1970 Jun;5(3):281–287. doi: 10.1016/0022-3468(70)90184-3. [DOI] [PubMed] [Google Scholar]
  12. Santulli T. V., Schullinger J. N., Amoury R. A. Malformations of the anus and rectum. Surg Clin North Am. 1965 Oct;45(5):1253–1271. doi: 10.1016/s0039-6109(16)37692-7. [DOI] [PubMed] [Google Scholar]
  13. de Vries P. A., Friedland G. W. The staged sequential development of the anus and rectum in human embryos and fetuses. J Pediatr Surg. 1974 Oct;9(5):755–769. doi: 10.1016/0022-3468(74)90115-8. [DOI] [PubMed] [Google Scholar]

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