title: Immediate and long-term results of surgical management of low imperforate anus in girls.
abstract: BACKGROUND
  The majority of girls with imperforate anus are reported to have a malformation of the low variety. Despite this, much of the literature has focused on the more complex, high lesions.
  
  
  METHODS
  This study reviews our experience with 44 girls with low imperforate anus from a 22-year period.
  
  
  RESULTS
  The incidence of associated anomalies was 61%, which is higher than generally reported. All patients in the study had anal fistulae. Fifty-seven percent had perineal fistulae, 23% had fourchette fistulae, and 20% had vestibular fistulae. Cutback anoplasty was performed in 55%, Potts transfer anoplasty was used in 27%, and 18% of patients were treated with either limited posterior sagittal anorectoplasty or anterior sagittal anorectoplasty. Surgical complications were uncommon. Long-term follow-up was carried out by telephone survey. This showed 89% of the girls to be successfully toilet trained. However, 47% of patients experience at least occasional soilage or episodic fecal incontinence.
  
  
  CONCLUSIONS
  Low imperforate anus can be successfully treated using a variety of procedures without colostomy. Most girls with low imperforate anus are successfully toilet trained, but problems with continence persist in a significant number of these patients.
authors.affiliation: C.S. Mott Children's Hospital, University of Michigan, Ann Arbor 48109-0245, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Javid
authors.forename: D C
authors.initials: DC
authors.lastname: Barnhart
authors.forename: R B
authors.initials: RB
authors.lastname: Hirschl
authors.forename: A G
authors.initials: AG
authors.lastname: Coran
authors.forename: C M
authors.initials: CM
authors.lastname: Harmon
mesh_terms: D001006:Anus, Imperforate / Q000145:classification / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000453:epidemiology; D012003:Rectal Fistula / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors; D014039:Toilet Training; D016896:Treatment Outcome