title: Combined posterior sagittal and three-flap anoplasty in the repair of anorectal anomalies.
abstract: OBJECTIVE
  The aim of this study was to describe a new technique for the repair of high and intermediate imperforate anus.
  
  
  METHODS
  From 1989 to 1999, 22 children with high and intermediate imperforate anus (17 boys, 5 girls) were operated on with a combination of a posterior sagittal and 3-flap perineal anoplasty. Long-term clinical follow up (to a maximum of 10 years) was done in all patients as well as a recent phone interview with a questionnaire regarding bowel function and degree of satisfaction with the result of the surgical correction. A continence ratio (CR, patient score/maximum possible score) was obtained by a blinded interviewer.
  
  
  RESULTS
  A continence survey was obtained in 19 patients. The average CR was 0.68. The CR for high anomalies was 0.62 and for intermediate anomalies was 0.78 (0.84 for girls and 0.64 for boys). Patients with sacral anomalies had a CR of 0.58. Two patients with Trisomy 21 had associated Hirschsprung's disease and were excluded from analysis.
  
  
  CONCLUSIONS
  Advantages of this combined surgical approach are excellent anatomic exposure, the ability to limit rectal mobilization to a minimum, reduction of the incidence of mucosal prolapse, the new skin-lined anal canal may assist attainment of continence by providing a "sensory warning zone," and, finally, the cosmetic appearance is satisfactory.
authors.affiliation: Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Bass
authors.forename: S Z
authors.initials: SZ
authors.lastname: Rubin
authors.forename: J M
authors.initials: JM
authors.lastname: Walton
authors.forename: M
authors.initials: M
authors.lastname: Cada
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D001006:Anus, Imperforate / Q000150:complications / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D017060:Patient Satisfaction; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*; D012005:Rectal Prolapse / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D016037:Single-Blind Method; D013524:Surgical Flaps / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000150:complications / Q000601:surgery*; D001747:Urinary Bladder Fistula / Q000150:complications / Q000601:surgery*; D014548:Urinary Fistula / Q000150:complications / Q000601:surgery*