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An incisional approach to the posterior perineum and inferior pelvis through a lateral buttock-reflecting incision has been described. This approach has been used in the surgical management of 7 patients with imperforate anus abnormalities. Attention has been directed toward the normal anatomy of the anorectum and the importance of restoring these normal relationships insofar as possible. In those cases in which the rectum ends above the levator muscles, it should be brought through the pelvic floor immediately behind the bladder and prostate in the male or the vagina in the female, so as to be in the grasp of the puborectalis sling. It is then directed posteriorly and inferiorly into the grasp of the circular deep and superficial external sphincter muscles. It is further desirable to construct a deep skin-lined anal canal to the level of the deep external sphincter so as to prevent mucosal eversion with its constant mucoid discharge.
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Received: May 25, 1964
☆Presented before the Surgical Section of the American Academy of Pediatrics, Oct. 5, 1963.
© 1965 Published by Elsevier Inc.