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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