Imperforate anus in male children: a new operation of primary perineal rectourethroanoplasty.

From experience in managing 348 patients with imperforate anus and after considering the existing literature, there appeared to be the possibility of performing a safe primary correction of supralevator anorectal anomalies via a perineal approach in the neonatal period in males. A total of 39 patients have been treated by the new operation, and in 31 of these patients the operation was carried out at birth. With a stiff catheter in the urethra, via a horizontal 'H'-shaped perineal incision and through the puborectalis sling, the rectum was mobilised and the fistula transfixed. The rectum was brought through the sling and sutured to the perineum so that perineal skin entered the new anal canal. In a few patients an abdominal approach was required at the same time. There were few postoperative complications. Subsequent X-rays showed good urethral and pelvic floor anatomy and function. Twenty-five of the babies are now over 2 years old. Of these, 84% are continent for solid faeces and 68% for liquid faeces. The perineal approach permits satisfactory identification of the puborectalis, rectum and fistula in most babies. Cutting the pelvic floor is not satisfactory. Introducing perineal skin into the anal canal is important. Early operation enables the child to learn to use its perineum. It is difficult to know whether the results in this series are attributable to the type of operation or its timing.