Imperforate anus repair

Alternative Names: 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.

See also: Imperforate anus

Description of Procedure

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.

Risks of Imperforate anus repair

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 urethra (tube that carries urine out of the bladder)
• Long-term problems with bowel movements because of damage to the nerves and muscles that supply the colon and rectum
• Temporary paralysis of the bowel (paralytic ileus)

Imperforate anus repair - series

Review Date: 12/11/2009
Reviewed By: Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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