Repair of low imperforate anus; with transposition of anoperineal or anovestibular fistula
CPT4 code
Name of the Procedure:
Repair of Low Imperforate Anus with Transposition of Anoperineal or Anovestibular Fistula
Summary
This surgical procedure is designed to correct a defect where the anus is either improperly formed or not connected correctly, specifically in cases where there is a fistula (an abnormal connection) between the anus and either the perineum or vestibule.
Purpose
The primary goal is to create a normal functioning anus and rectal passage, helping the patient maintain normal bowel control and function. This procedure addresses issues like improper stool passage and potential infections.
Indications
- Diagnosis of low imperforate anus.
- Presence of an anoperineal or anovestibular fistula.
- Symptoms include difficulty passing stools, noticeable abnormal openings, or recurrent infections around the anus.
Preparation
- Fasting for a specific period prior to the surgery (usually 6-12 hours).
- Adjustment of certain medications as advised by the surgeon.
- Diagnostic imaging, such as an ultrasound or MRI, to assess the anatomy and plan the surgery.
Procedure Description
- Administer general anesthesia to ensure the patient is asleep and pain-free.
- Position the patient, usually in a prone or lithotomy position.
- Make a surgical incision around the perineum.
- Locate and mobilize the rectal pouch.
- If a fistula is present, it is identified and divided.
- Reposition the rectal pouch to the normal anal position.
- Create a new anal opening and attach the rectal pouch.
- Close the incision with sutures.
Specialized surgical instruments and possibly a surgical microscope are used during the procedure.
Duration
The procedure typically takes about 2-4 hours, depending on complexity.
Setting
The procedure is performed in a hospital setting, often in a specialized pediatric surgical center for young patients.
Personnel
- Pediatric or colorectal surgeon
- Anesthesiologist
- Surgical nurses
- Pediatric intensive care team (for post-operative care)
Risks and Complications
- Infection
- Bleeding
- Anesthetic complications
- Narrowing of the newly created anus (stricture)
- Fistula recurrence
- Poor wound healing
Benefits
- Restoration of normal bowel function.
- Improved quality of life.
- Reduced risk of recurrent infections and other complications associated with an imperforate anus.
Improvements can be seen soon after recovery, but full benefits are most appreciated longer-term as the child grows and develops.
Recovery
- Hospital stay for 3-7 days post-operation for monitoring.
- Pain management with medications.
- Instructions on wound care and hygiene.
- Gradual reintroduction to a normal diet.
- Follow-up appointments to monitor healing and bowel function.
- Possible temporary stool softeners or medications to aid bowel movements.
Alternatives
- Less invasive interventions in specific cases, but might be less effective.
- Staged surgeries for complex cases.
- Non-surgical management involves symptom relief but does not correct the structural anomaly.
- Each alternative has its risks and benefits, often discussed in detail with the patient's family.
Patient Experience
Patients (or parents) can expect some discomfort post-surgery managed with pain relief medications. There may be temporary limitations on activity. Ongoing support and follow-up are crucial for successful outcomes and recovery.
Patient comfort measures include pain management and emotional support, especially vital in pediatric cases.