Name of the Procedure:

Repair of High Imperforate Anus without Fistula; Perineal or Sacroperineal Approach

Common Name(s):

• High Imperforate Anus Repair
• Perineal/Sacroperineal Anoplasty

Summary

This surgical procedure corrects a congenital condition where the anus and rectum do not properly develop, resulting in a blockage or absence of an anal opening. The surgery creates or corrects the anal opening through an incision made in the perineum or sacroperineal area.

Purpose

Medical Condition Addressed:

• Imperforate Anus without Fistula

Goals/Expected Outcomes:

• Creation of a functional anal opening
• Establishment of normal bowel function
• Prevention of complications such as infections and bowel obstruction

Indications

• Newborns diagnosed with high imperforate anus
• Absence of an anal opening
• Difficulty or inability to pass stool
• Abdominal distention

Preparation

• Fasting for 8-12 hours prior to surgery
• Pre-operative imaging studies (e.g., ultrasound, MRI) to determine the exact anatomy
• Blood tests to check overall health and readiness for surgery
• Emptying the bowel using an enema, if necessary

Procedure Description

1. Anesthesia: Administer general anesthesia to ensure the patient is unconscious and pain-free.
2. Incision: Make an incision in the perineal or sacroperineal area.
3. Creation of Anus: Identify and bring the rectum down to create a new anal opening.
4. Suturing: Secure the rectum to the muscle layers and skin to form the anus.
5. Closure: Close the incision with stitches or surgical adhesive.

Tools and Equipment:

• Surgical scalpel
• Retractors
• Sutures

Anesthesia:

• General anesthesia

Duration

The procedure typically takes 2 to 3 hours.

Setting

Performed in a hospital surgical suite.

Personnel

• Pediatric Surgeon
• Anesthesiologist
• Operating Room Nurses
• Surgical Technicians

Risks and Complications

Common Risks:

• Bleeding
• Infection

Rare Complications:

• Narrowing of the new anal opening (stricture)
• Damage to surrounding tissues
• Problems with bowel control

Benefits

• Establishment of normal bowel function
• Prevention of future health issues related to blocked or absent anus
• Improved quality of life

Recovery

• Initial hospital stay of 5 to 7 days
• Pain management with medication
• Careful monitoring of stool passage and healing
• Follow-up appointments for checking the surgical site and bowel function
• Restriction on certain activities for a few weeks (e.g., no heavy lifting)

Alternatives

• Colostomy (temporary or permanent) if immediate repair is not feasible
• Delayed repair when the patient is older and better able to tolerate surgery
• Each alternative comes with its own pros and cons, such as different risks and recovery times.

Patient Experience

• Expect some discomfort and need for pain management post-operation.
• Focused on rest and gentle care of the surgical site.
• Gradual return to normal bowel function and activities as guided by the healthcare team.