Use of the recto-urethral fistula for reconstruction of the anal canal in high anal atresia.

A 6-month-old boy with high anal atresia was operated upon via a sacro-perineal approach. After division of the rectourethral fistula, pressure recordings from the rectal part of the fistula during electrical stimulation of the rectal mucosa showed a resting pressure and relaxations resembling internal anal sphincter activity. The fistula was used for the reconstruction of the anal canal and anastomosed to the skin in the anal incision. The postoperative course was uneventful. Six weeks after the operation ano-rectal manometry showed a high resting anal pressure and normal internal sphincter relaxations. It is concluded that the presented surgical technique may provide a functioning internal sphincter in at least some patients with high anal atresia with recto-urethral fistula.