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    Imperforate anus repair

    Anorectal malformation repair; Perineal anoplasty; Anorectal anomaly; Anorectal plasty

    Imperforate anus repair is surgery to correct a birth defect involving the rectum and anus.

    An imperforate anus defect prevents most or all stool from passing out of the rectum.

    Description

    How this surgery is performed depends on the type of imperforate anus. The procedures are done under general anesthesia, which means the infant is asleep and feels no pain during the procedure.

    For mild imperforate anus defects:

    • The first step involves enlarging the opening where the stool drains so stool can pass more easily.
    • Surgery involves closing any small tube-like openings (fistulas), creating an anal opening, and putting the rectal pouch into the anal opening. This is called an anoplasty.
    • The child must often take stool softeners for weeks to months.

    Two surgeries are often needed for more severe imperforate anus defects:

    • The surgeon will create an opening in the skin and muscle of the abdominal wall and attach the end of the large intestine to the opening. Stools will drain into a bag attached to the abdomen. This is called a colostomy.
    • The baby is often allowed to grow for 3 - 6 months.
    • For the second procedure, the surgeon may make a cut in the abdomen to detach and move the colon to a new position. A cut is made in the anal area to pull the rectal pouch down into place and create an anal opening.
    • The colostomy will likely be left in place for 2 - 3 more months.

    A major challenge for these repairs is finding, using, or creating nearby nerves and muscles so that the child can move the bowels normally.

    Why the Procedure Is Performed

    The surgery repairs the defect so that stool can move through the rectum.

    Risks

    Risks from any anesthesia include:

    • Reactions to medications
    • Problems breathing

    Risks from any surgery include:

    • Bleeding
    • Infection

    Risk from this procedure include:

    • Damage to the urethra (tube that carries urine out of the bladder)
    • Damage to the ureter (tube that carries urine from the kidneys to the bladder)
    • Hole that develops through the wall of the intestine
    • Abnormal connection (fistula) between the anus and vagina or skin
    • Narrowed opening of the anus
    • Long-term problems with bowel movements because of damage to the nerves and muscles to the colon and rectum (may be constipation or incontinence)
    • Temporary paralysis of the bowel (paralytic ileus)

    After the Procedure

    The infant may be able to go home later the same dayas a mild defect is repaired. Or, the child may spend several days in the hospital.

    The health care provider will use an instrument to stretch (dilate) the new anus to improve muscle tone and prevent narrowing. This stretching must be done for several months. Stool softeners and a high-fiber diet are recommended throughout childhood.

    Outlook (Prognosis)

    Most defects can be corrected with surgery. Most children with mild defects do very well. However, constipation may be a problem.

    Children who have more complex surgeries still usually have control of their bowel movements. However, they often need to follow a bowel program,which includeseating high-fiber foods, taking stool softeners, and sometimes using enemas.

    Some children may need more surgery. Most of these children will need to be followed-up closely for life.

    Children with imperforate anus may also have other birth defects, including problems with the heart, kidneys, arms or legs, or spine.

    References

    Warner BW. Pediatric surgery. In: Townsend CM, Beauchamp RD, Eyers BM, Mattox KL, eds. Sabiston Textbook of Surgery, 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 71.

    Stafford SJ, Klein MD. Anus and rectum. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 336.

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    • Imperforate anus repair ...

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      • Imperforate anus repair ...

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      A Closer Look

        Tests for Imperforate anus repair

          Review Date: 11/21/2011

          Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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