Treatment recommendations will depend on the type of anorectal malformation, the presence and type of associated abnormalities, and the child's overall health. However, most infants with an anorectal malformation will require surgery.
Infants with a rectoperineal malformation require an operation called an anoplasty, which involves moving the anus to an appropriate place within the muscles that control continence called the anal sphincter.
Colostomy for Infants with Anorectal Malformations without a Fistula
Newborn boys and girls diagnosed with anorectal malformations without a fistula will require one or more operations to correct the malformation. An operation to create a colostomy is generally initially performed.
With a colostomy, the large intestine is divided into two sections, and the ends of intestine are brought through small openings in the abdominal wall.
The upper section allows stool to pass through the opening, called a stoma, and into a collection bag. Intestinal mucus exits through the opening of the lower section of intestine.
By performing this surgery, digestion will not be impaired and growth can occur before the next required operation. By diverting the stool, the risk of infection is minimized when the later reconstructive operation is performed.
Nursing staff and other healthcare professionals who work with the patient's surgeon will help parents learn how to take care of the colostomy, and they will assist them in making the transition from the hospital to home. Local and national support groups may also be very helpful during this time.
The next operation creates a connection between the rectum and the newly created anal opening. This procedure is usually performed from a posterior midline approach.
In some cases where the rectum ends within the abdomen (high lesions), minimally invasive (laparoscopic) surgery or traditional open surgery can be used to bring the rectum down to the anal opening.
The colostomy remains in place for six to eight weeks after this procedure so the area can heal without being infected by stool and so the patient can undergo a dilation protocol and the anus can reach the size appropriate for age. Even though the rectum and anus are now connected, stool will leave the body through the colostomy until it is closed with surgery.