Comparison of anorectal angle and continence after Georgeson and Peña procedures for high/intermediate imperforate anus.
OBJECTIVE
The anorectal angle (AA) influences defecation after pull-through (PT) for imperforate anus (IA). We compared postoperative AA and continence after Georgeson's laparoscopy-assisted colon PT (GPT) and Peña's posterior sagittal anorectoplasty (PSARP) for high/intermediate-type IA.


METHODS
We reviewed 33 high/intermediate-type IA cases (20 GPTs and 13 PSARPs) prospectively. All had colostomy initially as neonates. Anorectal angle was measured as the angle between the rectum and the anal canal on barium enema. A fecal continence evaluation questionnaire (FCEQ) consisting of 5 parameters (frequency of defecation, staining/soiling, perianal erosion, anal shape, and requirement for medication; maximum score = 10) was evaluated in 28 cases (15 GPTs and 13 PSARPs) followed up for more than 3 years.


RESULTS
Mean age at PT was similar (6.6 months for GPT and 6.3 months for PSARP; P = not significant). There was no significant difference in mean AA. The FCEQ scores for GPT were generally higher throughout the study and significantly better from 3 years postoperatively (P < .05).


CONCLUSIONS
We are the first to confirm that effective AA similar to PSARP can be achieved after GPT, although FCEQ would suggest that GPT has less detrimental functional impact.
Department of Pediatric General and Urogenital Surgery Juntendo University School of Medicine, Tokyo 113 8421, Japan.
Hiroyuki
H
Koga
Go
G
Miyano
Tsubasa
T
Takahashi
Akihiro
A
Shimotakahara
Yoshifumi
Y
Kato
Geoffrey J
GJ
Lane
Tadaharu
T
Okazaki
Atsuyuki
A
Yamataka
D000015:Abnormalities, Multiple / Q000601:surgery; D001003:Anal Canal / Q000473:pathology*; D000886:Anthropometry; D001006:Anus, Imperforate / Q000601:surgery*; D003125:Colostomy; D003672:Defecation; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005402:Fistula / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D011469:Prostatic Diseases / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D012003:Rectal Fistula / Q000601:surgery; D012006:Rectovaginal Fistula / Q000601:surgery; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014522:Urethral Diseases / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000601:surgery; D014548:Urinary Fistula / Q000601:surgery; D014621:Vagina / Q000002:abnormalities