Imperforate anus from birth to primary treatment.
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Two hundred and ninety cases of congenital anorectal anomalies were collected in a survey of the experience contributed by belgian surgeons over the last ten years (1971-1980). The incidence (1 in every 4,500 live births) and the sex ratio (56% males, 44% females) are similar to accepted figures in white race; this suggests that most of the cases have been included in the survey. The collected series was analysed according to the international classification proposed in 1970. It differs from most reported series 1 degrees in boys by the prevalence (58%) of low, infralevator types and the unusually high frequency of recto-vesical fistulas (versus recto-urethral); 2 degrees in girls, by the very high prevalence (80%) of low types and a relatively heavy incidence of low recto-vaginal fistulas (versus recto-vestibular). These characteristics could be partly related to a lack of accuracy in the diagnostic work-up. Every new case of anorectal anomaly should be accurately described and classified since the choice of surgical approach and the functional result are related to a large extent to the type and the level of the malformation. Use of the international classification is recommended.
The present series concerns the method of treatment for anus imperforatus as it was performed at the Academic Hospital Ghent (Belgium) between 1971 and 1980. Two different technics are confronted one with the other: the anterior perineal approach according to Mollard and the posterior transsacral approach according to Stephens. In agreement with the recent literature the anterior way of acceding to the puborectalissling has undeniable advantage. Even with a very short follow-up period the number of children with supralevatoric localization of anus imperforatus treated by the technic of Mollard and showing a proven continence is now already outnumber.