Imperforate anus repair

Definition

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. 

Alternative Names

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

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:

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

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:

Risks from any surgery include:

Risk from this procedure include:

After the Procedure

The infant may be able to go home later the same day as 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 includes eating 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.