Do Early Operations for Anorectal Malformations Produce Better Results?
Ideally, anorectal malformations should be repaired very early in life, when the child is approximately one month old. The advantages of early repair include:
- Patients do not need to have an open colostomy for a long time. The colostomy surgically creates an artificial opening (stoma) to allow feces to exit the body. Having an open colostomy a long time may cause problems, including atrophy of the bowel beyond the colostomy.
- Patients need anal dilatations after a surgical repair of an anorectal malformation. It is much easier for the parents to perform those dilatations when the baby is very young and the baby will not have any memory of these maneuvers.
Are there potential disadvantages of doing these operations early in life?
An article in the literature suggests that by putting the rectum in the right place early in life, perhaps the babies will learn bowel control better. This is, however, just a suggestion and lacks scientific support.
Much depends on the personal experience of the surgeon. A surgeon who is not familiar with the anatomy of a very tiny baby and does not have experience doing these operations early in a child's life might be wise to wait until the child is older and larger.
Recently, we analyzed the results from all the patients we have been operating on during the last 19 years and found that the patients that were operated on earlier in their lives, had better clinical functional results than those that were operated on later in life. We must acknowledge, however, that another potential explanation for these results is that the patients who had surgery earlier in their lives are those that were treated most recently, when we had acquired more experience.
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