Incidence of the postoperative complications in patients with low imperforate anus, and surgical managements following primary procedure of anoplasty are discussed. In 123 patients with low imperforate anus underwent primary anoplasty, 18 patients were performed secondary anal plastic surgery because of postoperative complications-anal stenosis, prolapse of rectal mucosa, recurrent fistula, and anterior anal site. Among the 18 male patients without fistula orifice who underwent perineal anoplasty (14;covered anus complete, and 4;anocutaneous fistula), second operation was necessary in the 4 patients with anal stenosis or remnant of fistulous tract. Cut back procedure was done in 49 patients (36;anocutaneous fistula, 6;anovestibular fistula, 6;anovulvar fistula, and one;anterior anus). In 12 female (6;anovestibular, and 6;anovulvar fistula), 3 patients required second operation for the anterior site of anus or perineal fistula. Z-type perineoplasty as a rectovaginal separation was effective for the female patient with anterior anal site following the cut back procedure. Potts' procedure was done in 50 patients (32;anovestibular, 10;anovulvar, and 8;anocutaneous fistula). In 5 patients with recurrent anovestibular fistula, 3 patients with rectal mucosal prolapse, and 3 patients with anal stenosis, second operations of various type were required. For the treatment of recurrent anovestibular fistula, recently, fistulectomy without colostomy became feasible by the aid of intravenous hyperalimentation and colon preparaion.
