Anterior perineal approach and three-flap anoplasty for imperforate anus: optimal reconstruction with minimal destruction.
Despite progress in the treatment of imperforate anus, anal stenosis, rectal prolapse, and other late complications may still arise. In 1987, we described the three-flap anoplasty for the treatment of rectal prolapse following pull-through operations. Since 1986, we have performed 14 three-flap anoplasties in combination with an anterior perineal rectal pull-through for primary treatment of imperforate anus. The mean age at definitive repair was 4.4 months (range, 0 to 14 months). Eleven of the 14 primary pull-through procedures could be performed through a perineal approach only. There were no deaths. At a mean follow-up of 24.2 months, none of the patients has developed prolapse, and only one has had a temporary stenosis. Three children are already fully continent, and soiling is absent in 12. All have a good sphincter tone. Although it is too early to evaluate long-term results, it appears that the three-flap anoplasty prevents mucosal prolapse through the interposition of a skin-lined anal canal. Moreover, a combination of this technique with the anterior perineal approach provides an excellent exposure with minimal dissection of the perineal and pelvic musculature and allows for easy and safe pull-through of the rectal pouch, making an abdominal counterincision unnecessary in most cases. It reproduces at the same time a normal anatomy while taking advantage of all existing structures.
Yazbeck
S
S
Department of Surgery, Saint-Justine Hospital, University of Montreal, Quebec, Canada.
Luks
F I
FI
St-Vil
D
D
D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D001006:Anus, Imperforate / Q000601:surgery*; D003248:Constipation / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005402:Fistula / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009132:Muscles / Q000601:surgery; D010502:Perineum / Q000601:surgery*; D012003:Rectal Fistula / Q000601:surgery; D012007:Rectum / Q000601:surgery; D013524:Surgical Flaps / Q000379:methods*; D014522:Urethral Diseases / Q000601:surgery