46740 Repair of high imperforate anus with rectourethral or rectovaginal fistula; perineal or sacroperineal approach

Name of the Procedure:

Repair of High Imperforate Anus with Rectourethral or Rectovaginal Fistula; Perineal or Sacroperineal Approach

Summary

This procedure corrects a congenital defect where the anus is not properly formed, creating abnormal openings between the rectum and the urethra (rectourethral fistula) or vagina (rectovaginal fistula). The surgery involves creating a proper anal opening and closing the abnormal connections, usually through an incision near the perineum or sacral area.

Purpose

The procedure addresses a high imperforate anus, a birth defect where the anus is absent or closed, and there are abnormal connections between the rectum and urinary or genital tracts. The goal is to create a functional anus and eliminate abnormal fistulas to ensure normal bowel function and prevent infections.

Indications

• Newborns diagnosed with high imperforate anus
• Presence of a rectourethral or rectovaginal fistula
• Symptoms such as inability to pass stool normally, recurrent urinary infections, or vaginal discharge in females

Preparation

• Fasting for 6-8 hours prior to surgery
• Medication adjustments as advised by the healthcare provider
• Pre-operative imaging tests such as an MRI or ultrasound to delineate the structures
• Blood tests to check overall health

Procedure Description

1. The patient is administered general anesthesia.
2. An incision is made near the perineum or sacrum.
3. The abnormal fistula is carefully separated from the surrounding structures.
4. The fistula is closed, and a new anal opening is created in the correct location.
5. The rectum is connected to the new anal opening.
6. The incision is closed with sutures.

Duration

The procedure typically takes 3-6 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Pediatric surgeon or specialized colorectal surgeon
• Anesthesiologist
• Surgical nurses
• Pediatric anesthetist (if applicable)

Risks and Complications

• Bleeding
• Infection
• Damage to nearby organs
• Stricture or narrowing of the new anus
• Recurrence of fistulas
• Difficulty with bowel control initially

Benefits

• Restoration of normal bowel function
• Reduced risk of infections
• Enhanced quality of life and long-term health outcomes
• Immediate improvements in symptoms, with full recovery in weeks to a few months

Recovery

• Hospital stay of several days post-surgery
• Pain management, initially with IV medication, then oral pain relievers
• Instructions for wound care and hygiene
• Restricted activities for several weeks
• Follow-up visits to monitor healing and function

Alternatives

• Non-surgical management (inadequate for long-term health)
• Temporary colostomy until the infant is older and stronger for surgery

Patient Experience

Patients are under general anesthesia and will not feel pain during the procedure. Post-operatively, discomfort and pain can be expected and managed with medications. The child may experience temporary difficulty with bowel movements, which will improve over time as healing progresses.