Challenges in imperforate anus: I--Primary perineal rectourethroanoplasty for anatomical and functional correction in males with supralevator anomalies.

Out of a total of 372 patients with imperforate anus, 99 males with high imperforate anus have been treated. Of these patients 34 have had a new operation through the perineum; 26 of these operations were done as a one stage procedure in the neonatal period. During the operation, through the perineum the puborectalis sling is identified, the recto urethral fistula divided, and the rectum mobilised and brought through the pelvic floor to be sutured to H flaps at the site of the original perineal incision in such a way that these flaps are drawn up to form part of the new anal canal. Post operative clinical and radiological evaluation show good urethral and rectal contours with good functional results. The good functional results are probably partly due to the timing of surgery and partly due to the type of operation.