Secondary anorectal surgery for the missed puborectalis muscle.

A detailed analysis and personal follow-up of 25 patients who underwent secondary anorectal surgery for incontinence suggests the following: (1) The puborectalis muscle is missed in pull-through surgery with greater frequency than is generally appreciated. (2) Direct visualization of the muscle at primary surgery can markedly reduce bowel misplacement. (3) Continence after secondary surgery improves with age, especially with the passage through puberty. (4) Secondary surgery improves sensation and thereby benefits continence. (5) No long term urinary problems appeared after reoperation. (6) Secondary surgery can restore a socially acceptable degree of continence in 3 out of 4 patients.