Posterior sagittal anorectoplasty for reoperation in children with anorectal malformations

A prospective study was carried out in 12 consecutive patients (7 boys and 5 girls), to evaluate posterior sagittal anorectoplasty for patients incontinent of faeces after anorectal reconstruction. Examination revealed anatomical problems such as: recurrent fistula (two), massive urethral diverticulum (one), absent vagina (one), and a missed urogenital sinus (one). Preliminary electromyography showed the external sphincter to be displaced from the anus in nine patients. Posterior sagittal anorectoplasty, with correction of anatomical defects and precise reconstruction of bowel within the sphincters, was carried out after the formation of a loop colostomy. No postoperative complications were observed. Contrast studies confirmed healed suture lines before stoma closure. Follow-up, between 4 and 46 months, revealed good faecal control in only two patients, with a significant improvement in two others. The rest remained incontinent although sensation was improved. These disappointing results, at variance with other published reports, lead us to conclude that posterior sagittal anorectoplasty, when used as a secondary procedure, is good for correcting anatomical defects but not for improving faecal continence.