The failed anoplasty: successful outcome after reoperative anoplasty and sigmoid resection.
OBJECTIVE
Children with anorectal malformations often have less than optimal results after repair. The authors report on five patients (ages 3 to 17 years) born with imperforate anus and treated with anoplasty as a newborn. At presentation, all patients were completely incontinent of stool. None had ever experienced voluntary bowel movements, and all wore diapers continuously.


METHODS
Perineal examination with the nerve stimulator showed the muscle complex was largely intact with good contraction, but the neoanus was outside of the muscle complex. Contrast enema showed massive dilation of the rectosigmoid colon and fecal impaction. A tethered spinal cord was excluded by magnetic resonance imaging (MRI). We treated these patients with a combined reoperative anoplasty via the posterior sagittal approach and sigmoid resection.


RESULTS
Within 6 months after the procedure, all patients had achieved complete continence. They had from one to three voluntary bowel movements per day without soiling.


CONCLUSIONS
Children with severe constipation and fecal incontinence after anoplasty should undergo evaluation by a surgeon. If examination shows a reasonably intact muscle complex and correctable anatomic defects, an excellent result can be achieved with appropriate reoperation.
Division of Pediatric Surgery, Stanford University School of Medicine, Packard Children's Hospital, Palo Alto, California 94304, USA.
R L
RL
Moss
D000293:Adolescent; D001006:Anus, Imperforate / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000601:surgery*; D003248:Constipation / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D012086:Reoperation; D016896:Treatment Outcome