For low imperforate anus, anoplasty is satisfactory. For all other lesions, a colostomy is recommended. Subsequent definitive surgery is often undertaken via a posterior sagittal midline approach. After isolation and repair of the fistula to the urethra/vestibula/vagina, the rectum is brought to the perineum through the sphincter complex, after which the sphincter complex is reconstructed posteriorly. More recently laparoscopic anorectoplasty has been described. Some patients may have persistent faecal incontinence despite reconstructive surgery because of deficient pelvic musculature and require treatment with the antegrade continence enema (ACE) procedure using the appendix as a conduit.
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