Pediatr Suvg Int (1993) 8 : 4 4 9 - 4 5 0

Pediao4c
Surgery
International
© Springer-Verlag 1993

Techr, ical innovations

Perin eal canal - repair by a new surgical technique
K. L. N. Rao, S. R. Choudhury, R. Samujh, and K. L. Narasimhan
Departmen: of Paediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India

Accepted 15 July 1992

Abstract, Perineal canal is an infrequently encountered

female anorectal anomaly. The available surgical tech-
niques for repair of this malformation are unsatisfactory
because of their high risk of recurrence. We present a new
surgical technique with posterior repositioning of the per-
ineal canal in continuity with the anorectum. The advan-
tages are a low risk of recurrence and excellent functional
and cosmetic results.

Key words: Anorectal malformations - Perineal canal

Introduction

Perineal canal [6] is a communication between the nor-

mally sitt ated anorectum and the vestibule. Various surgi- Fig. 1. Operative photograph showing fine of incision over perineal body
cal techniques have been described for its repair [2, 5, 7]. and perineal canal
We present a new technique of surgical repair of perineal
canal with satisfactory result.

Case report
A 3-month-:dd female presented with passage of stools per vaginam as
well as through the normal anal passage. There was no history of abscess
formation, c Larrhoea, or constipation. The anus was in the normal posi-
tion and hac normal sphincter tone. A small opening was noticed in the
vestibule jus: proximal to the fourchette, and insertion of a metallic probe
established a communication between the vestibule and the anus.
A preliminary divided sigmdid colostomy was performed, followed
2 weeks later by perineal surgery. A forceps was passed from the anal
opening into the perineal canal and the canal was laid open after incising
the perineal body (Fig. 1). The incision included skin, subcutaneous
tissue, a few fibres of external sphincter muscle, and one wall of the
mucosal tracl: through which the probe passed. A clear mucosa-lined tract
extending from the anorectum to the vestibule was noted. Starting from
the vestibule= end, the mucosal tract was dissected off from the underly-
Corresponde,~ce to: K. L. N. Rao
ing muscle maintaining mucosal continuity between the tract and the
anorectum. The external sphincter complex was restored by suturing the
cut ends with vicryl sutures and the perineal body was reconstructed. The
perineal canal mucosa, after being repositioned posteriorly in continuity
with the anus, was now sutured to the skin edges to complete the ano-
plasty. Postoperative wound healing was uneventful and the patient has
normal bowel activity after colostomy closure and a normal cosmetic
appearance.
Discussion
Perineal canal [6], or double termination of the alimentary
tract [2, 7], or anorectal-vestibular fistula without imper-
forate anus [7] in females is a rare malformation. This
anomaly is seen more frequently in Asian countries, no-
tably Japan, China, and and Vietnam in addition to India
[1, 7]. Controversies exist regarding the origin of these
tracts: Although there are embryologic bases suggesting a