Anorectal Malformation Treatment
According to Alberto Pena and Marc A Levitt, Anorectal malformations occur in about 1 out of 5000 live births.
Anorectal malformations refer to a large group of diseases that involve rectum, distal anus, as well as genital and urinary tracks. They are birth defects that occur during the development of a fetus, leading to poor development of the rectum and anus. These complications affect both girls and boys, with boys facing a slightly higher risk.
While some anorectal malformations are relatively easy to treat, others are complex and often come with some complications.
Doctors used to treat imperforate anus by creating an orifice in the affected children's perineum. Only children with "low" defects survived.
Amussat performed the first anoplasty in 1835 by suturing the rectal wall to the edges of the skin.
When posterior sagittal approach was introduced in 1980, it dramatically changed the surgical approach to anorectal malformations treatment. The approach enabled doctors to have a better view of the complications. They learned more about the complex anatomic arrangement at the genitourinary tract and rectum junction. The surgeons could also repair the complications under direct vision.
Depending on the level of complication, laparoscopy may be used hand in hand with the posterior sagittal approach.
Colostomy involves dividing the large intestine into two and bringing the ends through openings in the abdomen. The lower section lets the mucus the intestine produces collect into a bag while the upper section lets stool collect into another bag. Colostomy does not affect digestion.
A later operation is done to attach the rectum to the anus. The colostomies will still not be removed for several months to let the area heal without risk of infection. They will be closed about three months later, after which the child is not given any food for some days so the intestines can have enough time to heal.
Surgeons are concerned about three primary areas when repairing the malformations, namely sexual function, urinary control and bowel control. Better functional outcome is achieved when the problem is diagnosed early.
Doctors consider a number of factors to determine the best type of treatment, including the level of complication, health of the affected child, what is expected from the course of the disease as well as the opinions of both the parent and physician. Many of the affected children need to undergo surgery. Different types of abnormalities require different types and numbers of operation (see ref 2).
1. Alberto Pena, Marc A Levitt, Anorectal malformations. Retrieved on July 31, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1971061/
2. Children's Memorial Hospital, Anorectal malformations. Retrieved on July 31, 2011 from http://m.childrensmemorial.org/depts/pediatricsurgery/anorectal-malformations.aspx