This procedure is used to treat two main anorectal problems:
- Anal Stenosis
- Congenital Anal Defects in Children
Anal stenosis is usually caused due to a complication of an anorectal procedure most commonly seen after a hemorrhoidectomy procedure. Studies have shown that an over zealous hemorrhoidectomy causes 90% of anal stenosis.
Congenital anal defects in children
Congenital anal defects or an anal stenosis is a common problem among children and most often detected at birth. When the child is born the anal cavity may not have formed properly leaving a very narrow anal canal. A narrow anal canal makes it difficult for stool to be passed or it may not pass at all stopping at the rectum. This is a problem and will need correcting immediately.
The procedure may only be one step, or it can be three depending on the severity of the problem. There are a few complications to surgery, but with congenital anal defects, it is the only form of treatment.
What causes a child to require an anoplasty?
In the womb, a child’s body develops at different stages. During this developmental process, if anything goes wrong, the child will suffer from a congenital disability. Congenital birth defects can form almost anywhere throughout the body. We hear about congenital birth defects in the lip, ears, and feet but are not as familiar with defects in the digestive tract. The digestive system must develop properly, or else you will have trouble breaking down food and passing food through the intestine to be removed as waste. When the anus does not form properly or at all, children are not able to pass stool out of the body properly.
Anal stenosis is a defect that creates an anal cavity that is too narrow. This disorder does not have to be congenital; it is something that can develop as an adult, but in most cases, it is a congenital problem. Anal stenosis makes bowel movements difficult and extremely painful. For babies, bowel movements are nearly impossible. A congenital imperforate anus is a problem that is characterized by a lack of an anus. The colon connects to the rectum which connects to either a pouch or a fistula. The pouch collects the stool. The fistula is an abnormal channel that connects two different organs. The fistula may connect to the bladder or the genitalia. In girls, it connects to the vagina, and in boys, it connects to the base of the penis.
Anoplasty surgery for children and adults
Surgery can be performed in one step while some patients may need multiple procedures to correct the problem. During the procedure, the surgeon widens the anal opening making it easier for stool to pass. If the patient is also suffering from anal fistulas, the surgeon will need to fix the fistula(s) first. The procedure for closing fistulas may include filling them with tissue or patching with your tissue. The filling and patch are both made of tissue that is either from your body or another biological organism.
Severe imperforate anus will require more, surgery. The first procedure may be a colostomy. In this surgery, part of the colon is placed into a hole in the abdominal cavity. A bag is attached to the abdominal wall to collect the waste. After a period of about six months, the doctor moves the colon into a new place creating a new anal opening. The rectal pouch now becomes the anal cavity. The doctor will leave the colostomy bag in place for another few months until the incision heals completely, removing it at a later date.
Following the surgery, patients will have anal stretching exercises to perform for several months. Anal stretching prevents the new cavity from becoming too narrow again and increases muscle tone.
Risks of anoplasty surgery in children and adults
There are risks with any procedure most of the time patients prognosis is great; they are still able to control their bowel movements. For the most severe cases accompanied by other defects, the child and adults need to be monitored throughout their life.
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