Monday, August 21, 2017

Pediatric surgery Ano-Rectal malfomations

Anorectal Malformation
Definition
In cases of development defect of anus, babies are born with imperforate anus and with or without abnormal fistulous connections.
Objectives
   To bring the bowel down at the anal site
   To preserve the sphincteric mechanism for anal continence.
Position
   Prone with buttocks raised at 45 degree angle
   Pass Folley’s catheter into the bladder before positioning.
Anesthesia
General with endotracheal intubation.
Procedure
   1.  A midline incision from sacrococcygeal region to the proposed anal site.
   2.  Divide the subcutaneous tissue and the sphincteric muscle complex strictly in midline with a fine tipped diathermy.
   3.  Hook and divide the puborectalis muscle fibers in the midline.
   4.  Open the rectum in the midline, between the stay sutures.
   5.  Identify, isolate and suture the fistula.
   6.  Lengthen the rectum by dividing the fibrovascular bands.
   7.  Place the neorectum through the sphincter muscle complex, checking with muscle stimulator.
   8.  Fix neoanus at the anal site.
   9.  Close the bifurcated coccyx.
10.  Close the midline wound in layers.
Instruments
General pediatric set.
Special
   Muscle stimulator                             1
   Mastoid retractor                               2
   Right angled artery forceps             2
Sutures
   Vickryl                    4/0, 5/0
   Catgut       4/0

   Nylon                     4/0.

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