title: Treatment of anorectal anomalies by anterior perineal anorectoplasty.
abstract: OBJECTIVE
  The aim of this study was as an introduction of a technical modification to the anterior perineal approach for the treatment of anorectal anomalies (AA) and analysis of its long-term results.
  
  
  METHODS
  Forty-three children with AA underwent a modified anterior perineal anorectoplasty (APA), which involved the following technical guidelines: construction of a rectoanal muscular conduit through the levator ani muscle and the external anal sphincter, which were sutured to each other; preservation of the rectal end of the fistula; and invagination of the perineal skin through the neoanus. Fecal continence was assessed on average 7 years postreconstruction by Kelly's score.
  
  
  RESULTS
  Of the 20 patients (19 boys) with high AA, results were good, fair and poor in, respectively, 50%, 30%, and 20% of them. Results were good and fair in, respectively, 79% and 21% of the 14 patients (all girls) with intermediate AA. All 9 patients (7 boys) with low AA had good results. The differences among groups were statistically significant (P = .016).
  
  
  CONCLUSIONS
  This modified APA allows for the surgeon to securely identify, preserve, and reconstruct all anatomic structures that are relevant for fecal continence. The long-term results of this initial series suggest that this modified APA is a valuable alternative for the treatment of AA.
authors.affiliation: Division of Pediatric Surgery, Santa Casa de Misericórdia Central Hospital and Santa Casa School of Medical Sciences, São Paulo, Brazil.
authors.forename: F D
authors.initials: FD
authors.lastname: do Amaral
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery*