Female - No fistula

This is a female infant with an anorectal malformation and there is no fistula.

On the distal colostogram, the rectum is blind ending.

The muscle stimulator shows the center of the sphincter mechanism.

A posterior sagittal incision is made through the center of the sphincter mechanism.

The rectum is low and is identified.

Silk sutures are inserted to assist in the dissection by allowing uniform traction on the tissues.

Mobilization of the rectum is started on the lateral wall.

Once the plane of dissection is identified, the dissection moves to the anterior wall and the rectum is mobilized off the vagina.

Once adequate length is achieved, a standard anoplasty is performed.

Absorbable suture is used to tack the rectum to the posterior border of the muscle complex.