Advantages of performing the sagittal anoplasty operation for imperforate anus at birth

  • Thomas C. Moore
    Address reprint requests to Thomas C. Moore, MD, PhD, Division of Pediatric Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509.
    Department of Surgery, UCLA School of Medicine, and the Division of Pediatric Surgery, Harbor-UCLA Medical Center, Torrance, CA USA
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      The development of the posterior sagittal anorectoplasty approach has been a major recent advance in the repair of imperforate anus. It has been found that sagittal anoplasty can easily and preferably be carried out in the newborn period without the need for colostomy or “tapering”. It is suggested that the perineal sagittal approach be attempted first, with the infant positioned so that the abdominal part of the abdominoperineal approach can be used if necessary—this seldom may be required. Neonatal closure of urinary tract fistulas in boys is an added attractive feature of this approach. The importance of optical magnification (microsurgery) and excellent, intense lighting of the perineal area with a headlamp is stressed for this approach in the newborn, particularly for the management of high pouches and high fistulas. This operation at birth relieves alimentary tract obstruction at birth, eliminates urinary tract contamination (when it exists) at birth, establishes anorectal continuity and maximum potential for “normal” defecation reflexes at birth, and achieves all of this in one rather than three operations.


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        • Pena A
        • deVries PA
        Posterior sagittal anorectoplasty: Important technical considerations and new applications.
        J Pediatr Surg. 1982; 17: 796-811
        • Stephens FD
        • Smith ED
        Anorectal Malformations in Children.
        Year Book Medical, Chicago, IL1971
        • Moore TC
        • Lawrence EA
        Congenital malformations of the rectum and anus: I. Clinical features and management in 120 cases.
        Surgery. 1952; 32: 352-366
        • Moore TC
        • Lawrence EA
        Congenital malformations of the rectum and anus: II. Associated anomalies encountered in a series of 120 cases.
        Surg Gynecol Obstet. 1952; 95: 281-288
        • Rhoads JE
        • Pipes RL
        • Randall JP
        A simultaneous abdominal and perineal approach in operations for imperforate anus with atresia of the rectum and rectosigmoid.
        Ann Surg. 1948; 127: 552-556
        • Moore TC
        Lambrect W Lierse W The internal sphincter in anorectal malformations: Morphologic investigations in neonatal pigs. ed 2. J Pediatr Surg. 22. 1987: 1167 (discussion)