Anoplasty
Anoplasty is a surgical procedure performed to reconstruct the anus and to widen the anal canal. This operation is performed primarily to correct a congenital abnormality called imperforate anus in which the infant's anal opening is blocked or completely closed. The other is to correct severe cases of anal stenosis in which the anal canal is abnormally narrow making it difficult to defecate. The majority of cases of adult anal stenosis occur as a complication of a surgical procedure in the area, most commonly a hemorrhoidectomy. If anal stenosis is mild, it can be treated successfully by nonsurgical methods, but if it is severe it requires an anoplasty.
Children with imperforate anus may also have other birth defects that require surgical correction.
The Anoplasty Procedure
Performed under general anesthesia, an anoplasty involves stretching the anal canal so that stool can be passed comfortably. There are many different methods of performing an anoplasty, depending on the patient's anatomy and overall medical condition, including radiofrequency ablation and anal encirclement.The most challenging aspect of performing an anoplasty is creating an adequate anal opening without damaging adjacent muscles or nerves so that the patient can move the bowels normally and does not become incontinent.
In more serious cases, a temporary colostomy may be necessary to allow waste to exit the body through a surgically created opening (stoma) before, during, or after the procedure.
Anoplasty for Imperforate Anus
When the surgeon must repair an infant's imperforate anus, there are two surgeries involved. First, the surgeon performs a colostomy during which:
- A stoma (opening) is created in the abdominal wall
- The end of the colon is attached to the stoma
- A bag to collect fecal waste is connected to the stoma (a colostomy)
The baby lives with the colostomy bag for 3 to 6 months, after which the second operation is performed. During the second procedure, the surgeon:
- Makes an incision in the abdomen
- Detaches and moves the colon to a new position
- Puts a rectal pouch into place
- Creates an anal opening using adjacent muscles and nerves
- Close any existing fistulas (abnormal passageways)
- Typically leaves the colostomy in place for another 2 to 3 months
- Reverses the colostomy so that the child begins to pass stool normally
Usually, it is necessary for the patient to take stool softeners for several weeks or months until the elimination process stabilizes. Some children who have undergone an anoplasty require bowel management throughout their lives.
Anoplasty for Anal Stenosis
In most cases, anal stenosis can be effectively treated with more conservative methods, such high fiber diet supplements, anal dilations, the administration of stool softeners, or enemas. When an anoplasty becomes necessary to relieve symptoms, it may be performed as one of various flap procedures and may or may not require a temporary colostomy.
Many patients are able to undergo the anoplasty on an outpatient basis, but if the surgery is particularly complex, or the patient is an infant or otherwise especially vulnerable, a short hospital stay may be necessary.
Recovery from an Anoplasty
The stitches in the anal canal will dissolve on their own and the wound is usually completely healed in several weeks. Some patients may experience a small amount of bleeding in the days after the anoplasty, but for most patients the surgery goes smoothly. Both children and adults are administered high fiber diets, laxatives and, possibly, mineral oil, to make defecation as easy as possible.
It is important for all patients who have undergone an anoplasty that the anal and perianal areas be kept very clean to avoid skin irritation and infection.
Risks of an Anoplasty
As previously mentioned, the anoplasty is a delicate operation whatever the age of the patient since the surgeon is focused on avoiding damage to adjacent organs, muscles and nerves, particularly the bladder, kidneys,urethra, ureters, vagina, and colon.
In addition, an anoplasty carries the risk of inherent in an surgical procedure, such as breathing problems, adverse reactions to medications or anesthesia, excessive bleeding, and postsurgical infection. Nonetheless, most anoplasty are highly effective. Infants who undergo such operations most often go on to live normal, healthy lives.