WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Dr. Rekan Moflih Darak*, Dr. Waad Idrees Abdullah, Dr. Harith Hameed Majeed

ABSTRACT

Background: The treatment of anorectal abnormalities is difficult and extremely complicated. Careful preoperative and surgical planning must be carried out in order to produce the desired results in children with this diagnosis. Additionally, bowel control and lifelong care are important for patient success. Objective: To study the management of imperforate anus and the proper surgical procedure for each type. Patients and Methods: A prospective study of 80 case of imperforate anus. Setting: All of our patients managed at Al-Khansa'a Hospital between September 2010 and September 2012. Results: Prenatal history shows positive polyhydramnios in 27.5%. Fifty one percent presented with acute intestinal obstruction in the first week of life. Of these 80 cases 47.5% were high lesion, 18.7% intermediate lesion and 30.0% low lesion. Thirty one percent of male lesions were recto urethral fistula as the commonest male lesion while recto vestibular fistula represents the commonest female lesion (12.5%). Forty percent has associated anomalies involving different systems. Cross table radiograph used to determine the level of the lesion shows 80.0% true results, while the remaining 20.0% failed to predict the level of the lesion. Distal colostogram used for identification of urinary fistula and it was true positive in 40.0% while in the remaining 60.0% fistulae were detected per operatively. Low lesions managed by one stage perineal approach using cruciateanoplasty in 14 patients, anal transposition in 7 patients and cut back operation in 2 patients, five patients with anal agenesis successfully treated by one stage cruciateanoplasty. Three stage operations using posterior sagittal anorectoplasty were the standard technique for the remaining lesions in 92.5% and in the remaining 7.5% an abdominal approach was added. Conclusions: High lesion carries the highest incidence of associated anomalies which is responsible for majority of the deaths, and genitor-urinary anomalies are the commonest. Cross table radiograph and distal colostogram carry a significant percent of false results. Low lesions and anal agenesis can be managed through perineal approach without colostomy. Posterior sagittal anorectoplasty is the optimal surgical procedure for high lesions and rectovestibular fistula.

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