“High” anorectal anomalies treated by early (neonatal) operation

Between 1973 and 1983, 18 patients with “high” anorectal anomalies were treated by one of the authors (N.V.F.) by immediate sigmoid loop-colostomy, followed by a sacroperineal or abdominosacroperineal pull-through operation as soon as possible thereafter. This was performed in seven patients between 1 and 14 days, in seven patients between 15 and 40 days, and in four patients between 60 and 120 days. Daily anal dilatations were started 7 to 10 days postoperatively and continued until the anus was soft and supple. The colostomy was then closed, the aim being to complete all treatment by the age of 3 to 4 months. Continence was assessed using Kiesewetter's criteria. Results in 70% were “good”, 18% “fair”, and 12% “poor”. The clinical results are discussed together with the possible advantages of definitive surgery in the neonatal period for “high” anorectal anomalies.