Surgical treatment of high imperforate anus

One hundred thirty‐two operations for congenital anorectal malformations have been done employing a new surgical procedure. A sacroperineal approach through the midline with division of the external sphincter and levator muscle groups is used. The rectourinary fistula is separated by a submucosa dissection. The rectum is tapered to a smaller calibre and placed within the open levator system. The entire sphincter complex is reconstructed posterior to the pulled‐through rectum. The approach provides excellent exposure of the important anatomical and functional structures of the pelvis. Our operative experience indicates that a reassessment of traditional concepts of the surgical anatomy of the perineum is necessary. The operation was used in 53 patients with high imperforate anus and rectourethral fistula, 19 patients with repair of previous imperforate anus operations, 14 patients with persistent cloaca, and 46 patients with similar anorectal conditions. The preliminary results are highly encouraging in regard to early continence and toilet training.