Aira Hospital

Imperforate anus is a congenital malformation with absent anal opening. Usually the parents seek help early since it is obvious that something is wrong when the child is not passing stool and there is no anal opening.

 

The very mild form where the anus is covered by a thin layer of skin - often with a tiny fistula opening from which small amount of stool passes - is called “covered anus”.

 

A simple “cut back” will relieve that condition

 

Otherwise a formal reconstruction has to be done. As the patient usually arrives early before severe abdominal distention has occurred colostomy is seldom needed. It actually makes dissection of the rectum easier when it is dilated and filled with meconium and stool.

The procedure is a Posterior Sagital Ano Rectal Plastic:

Position on the operating table

 

The incision is posterior sagital through the skin, subcutis and levator muscles. The Coxyx is excised to make access easier

 

The rectum is dissected and mobilized. Most often there is a small fistula to the urinary tract anteriorly which has to be cut and ligated. A catheter in the bladder helps preventing injury to the lower urinary tract.

 

The anterior part of the anorectal anastomosis is done and the levator muscles closed meticulously in the midline after which the anastomosis is completed.