Reappraisal of endorectal pull-through procedure. I. Anorectal malformations.

Postoperative continence in anorectalmalformations was assessed by clinical score, rectoanal manometry, and electromyography. The results in low deformities operated by perineal rectoplasty showed "good" clinical scores, good preservation of the rectoanal reflex, and good electrical activity of the external sphincter. High deformities, on the other hand, showed low clinical scores, poor recordings of the rectoanal reflex, and diminished electrical activity around the anus. Analysis of high deformities treated by operative procedures, however, indicated better clinical scores and better preservation of rectoanal reflex in those who had undergone the endorectal pull-through procedure (Rehbein) than those who had had an abdominoperineal pull-through procedure. Furthermore, dissections of newborns with a rectourethral fistula revealed the presence of the puborectalis sling around the terminal rectum and fistula in a hammock fashion. This finding supports our suggestion that the colon can be safely pulled-through within the sling by the original Rehbein procedure without sacral dissection.