Secondary sagittal posterior anorectoplasty.

From October 1984 to December 1986, 25 continence-improving operations were performed at the Paediatric Surgical Clinic of the Children's Hospital, Cologne. Smooth muscle inversion plasties were carried out during abdominosacroperineal pull-through procedures in eight neonates. Anterior sagittal anorectoplasties were employed in four female neonates. Secondary continence-improving procedures had to be carried out in 13 patients, with secondary sagittal anterior rectoplasties in 5 instances and posterior sagittal anorectoplasties in another 7 instances. Gracilis transposition according to Pickrell was employed in one boy. Among the seven children who underwent posterior sagittal rectoplasty, there were four patients where remnants of earlier gracilis or gluteus maximus plasties could be additionally used for creation of a continent sphincter apparatus. Among the 13 older patients with secondary continence-improving operations, 7 achieved complete continence and 6 markedly improved continence effecting continence for solid and pultaceous stools, but soiling under stress and diarrhoea. No child remained entirely incontinent.