Preservation of infralevator structures in imperforate anus repair.

In this report, we describe the most recent refinements to the anterior perineal approach originally described by Mollard for the repair of high and intermediate forms of imperforate anus. A skin tube is constructed from perineal skin, passed through the center of the external sphincter, and anastomosed to the fully preserved rectum with or without tapering. The anastomosis lies within the puborectalis sling and is anchored to the striated muscle complex. Sixteen patients have been operated on by this technique with excellent anatomic results in 15 patients and excellent early functional results in patients who are 2 years of age or older.