Health Encyclopedia

Imperforate anus repair

Definition

Imperforate anus repair is surgery to correct birth defects involving the rectum and anus. An imperforate anus defect prevents little or no stool from passing out of the rectum.

Alternative Names

Anorectal malformation repair; Perineal anoplasty

Description

This surgery repairs the defect so that stool can move through the rectum. If the baby has no anal opening at all, emergency surgery is needed.

The procedure is done under general anesthesia, which means the patient is asleep and feels no pain during the procedure.

Surgery depends on the type of imperforate anus defect.

For a high-type imperforate anus defect, the surgeon usually creates a temporary opening for the colon in the abdomen. This is called a colostomy. The baby is allowed to grow for several months before more complex repairs are attempted.

Surgery for a low-type imperforate anus involves closing any small tube-like openings (fistulas), creating an anal opening, and putting the rectal pouch into the anal opening.

For other related anal repairs, the surgeon makes a cut in the abdomen and loosens the colon from nearby structures. This allows the colon to be re-positioned. A cut in the anal area is made to pull the rectal pouch down into place and create an anal opening. A colostomy may be closed during this procedure, or may be left in place for a few more months and closed at a later stage.

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

Why the Procedure Is Performed

This surgery is done to repair an imperforate anus.

Risks

Risks for any anesthesia include:

Reactions to medications
Problems breathing

Risks for any surgery include:

Bleeding
Infection

Risk specific to this procedure include:

Damage to the muscles that support the pelvis
Damage to the urethra (tube that carries urine out of the bladder)
Temporary paralysis of the bowel (paralytic ileus)

After the Procedure

Most anorectal malformations can be corrected successfully with surgery. In most cases, patients recover with normal bowel function. The long-term outlook is excellent if the patient has no other pelvic problems.

Outlook (Prognosis)

The child may spend several days in the hospital. The health care provider will use an instrument to dilate (stretch) the new anus to improve muscle tone and prevent narrowing -- this must be continued for several months. Use of stool softeners and a high-fiber diet are recommended throughout childhood.

Review Date:11/9/2007
Reviewed By:Deirdre O’Reilly, MD, MPH, Neonatologist, Division of Newborn Medicine, Children’s Hospital Boston and Instructor in Pediatrics, Harvard Medical School, Boston, Massachusetts.

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