Defects in Operations for Imperforate Anus.

IN THE BEGINNING the authors discuss the high type of imperforate anus because they say the low type presents "no real problem in achieving continence." They ment ion a report by Partridge and Gough 4 in which they found that "only half the survivors of high anomalies had adequate continence." They say that factors involved in continence are specific sensation of the rectum and anal canal, and "on the motor side" the puborectalis sling with the external sphincter forming the striated sphincter and the internal sphincter probably preventing soiling ra ther than frank incontinence. T o them it appears that it is not essential for all these factors to be effective to achieve continence. They support this theory by Swenson's operation which they say shows that continence "can be achieved without rectal sensation providing anal canal sensation is normal. On the other hand," they say, " t rea tment of imperforate anus with vulval fistula by simple cutback and dilatation shows rectal sensation alone can suffice for there is no normal anal canal lining." They believe that inferiority of results in high anomalies might be due either to inadequate development of the more sensitive lower part of the rectum or to division of the parasympathet ic afferent nerves while mobilizing the bowel for pull-through operation. In an a t tempt to settle this point they investigated before definitive operation 10 patients with colostomies.