Imperforate Anus: Low Type

Abstract

The first step to treat a patient with imperforate anus is to make diagnosis of the type correctly. Newborn babies with low-type anomaly mostly have a fistula opening. Cutback operation can be a radical operation for a newborn baby with low-type, but it may not be enough for incising the external sphincter muscle to prevent postoperative constipation. The author prefers to manage bowel movements with glycerin enemas via the opening until around 6 months of age. The radical anoplasty is cutting the muscle backward for most boys with low type and when the opening is near the anal pit in girls. Anal transplantation is another anoplasty for girls with anovestibular fistula or anovulvar fistula and boys with a fistula away from the anal pit. For rare low type, covered anus complete, perineal anoplasty using endoscopy can be an option. Postoperative management includes daily enemas with dilatation just after surgery. Because constipation is the major concern for patients with low-type anomaly, care should be continued for a long time preferably by the time they go to school.

The figures in this chapter are reprinted with permission from Standard Pediatric Operative Surgery (in Japanese), Medical View Co., Ltd., 2013, with the exception of occasional newly added figures that may appear.