Perineal Anoplasty

What is Perineal Anoplasty

• Perineal anoplasty is a surgery that may be done to treat imperforate anus, a condition where the anus is missing, blocked, or in the wrong place. The goal of surgery is to create a safe way for stool to leave the body.
• A perineal anoplasty is usually done when a child is 1 or 2 days old.
• Perineal anoplasty, also known as anorectal reconstruction or perineal reconstruction, is a surgical procedure performed to correct congenital anomalies or acquired conditions affecting the anus and rectum.
• The procedure aims to create a functional and anatomically normal anal opening.

What are the indications of Perineal Anoplasty?

The main indications for perineal anoplasty include:

1. Imperforate Anus: Imperforate anus is a congenital condition where the anal opening is absent or improperly formed, preventing the passage of stool. Perineal anoplasty is the primary treatment to create a functional anal opening.
2. Anorectal Malformations: Various complex anorectal malformations may occur during fetal development, leading to abnormalities in the anus and rectum. Perineal anoplasty is often part of the surgical management to correct these malformations.
3. Hirschsprung’s Disease: Hirschsprung’s disease is a congenital condition characterized by the absence of nerve cells (ganglion cells) in parts of the colon. This leads to an obstruction and impaired motility in the affected segment. Perineal anoplasty may be performed as part of the surgical treatment for Hirschsprung’s disease.
4. Cloaca: Cloaca is a severe congenital malformation where the rectum, vagina, and urethra share a common opening in the perineum. Perineal anoplasty is one component of the surgical correction for cloaca.
5. Rectovestibular Fistula: In this condition, there is an abnormal connection between the rectum and the vestibule of the vagina. Perineal anoplasty is performed to create a separate anus and correct the fistula.
6. Acquired Anorectal Injuries: Traumatic injuries or damage to the anal region may necessitate perineal anoplasty to repair and reconstruct the affected structures.
7. Fecal Incontinence: In some cases of severe fecal incontinence, perineal anoplasty may be considered as a treatment option to improve bowel control.

Tell a health care provider about:

• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or members of your family have had with anesthetic medicines.
• Any blood disorders your child has.
• Any surgeries your child has had.
• Any medical conditions your child has.

What are the risks of Perineal Anoplasty?

Generally, this is a safe procedure. However, problems may occur. Possible short-term complications include:

• Excessive bleeding.
• Pain.
• Infection at the incision site.
• Slow healing.
• Pooling of blood under the incision (hematoma).
• Severe diaper rash.
• Nerve damage.
• Constipation.
• Incontinence.
• Damage to the urinary tract.
• A wound or incision breaking open.

Possible long-term complications include:

• Scarring.
• Damage to blood vessels in the area.
• Difficulty passing stool.

What happens before the procedure?

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink water.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating foods.
• 6 hours before the procedure – have your child stop drinking formula or milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking water.

Medicines

• Give over-the-counter and prescription medicines only as told by your health care provider.
• Ask your health care provider about changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.

General instructions

• If you were asked to wash your child with a germ-killing soap, make sure to do so as told by your child’s health care provider.

What happens during the Perineal Anoplasty procedure?

• To reduce your child’s risk of infection:
  • Your child’s health care team will wash or sanitize their hands.
  • Your child’s skin will be washed with soap.
  • Your child may be given an antibiotic medicine.
• Small monitors will be put on your child’s body. They will be used to check your child’s heart rate, blood pressure, and oxygen levels.
• An IV tube will be inserted into one of your child’s veins to provide fluids and medicine.
• Your child will be given one or more of the following:
  • A medicine to help your child relax (sedative).
  • A medicine to make your child fall asleep (general anesthetic).
• Your child will be positioned face-down.
• If your child has an abnormal opening (fistula), it will be closed.
• A new opening will be made where the anus is supposed to be.
• The rectum will be pulled down and stitched to the inside of the new opening.
• A piece of your child’s colon may be redirected (diverted) to an opening in the abdomen (stoma). This process, known as colostomy, will divert stool to a bag outside the body. A colostomy may be temporary.

The procedure may vary among health care providers and hospitals.

What happens after the Perineal Anoplasty procedure?

• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines your child was given have worn off.
• You may be able to hold your child as soon as he or she starts to wake up.
• A cream may be put on the area around your child’s new anus. The cream helps prevent diaper rash, which often develops after the procedure.
• Follow instructions from your health care provider about when to give your child breast milk or formula.
• Your child will be given medicines:
  • To help with pain.
  • To make stool easier to pass through the anus (stool softener).
• Your child’s stool may be diverted to a stoma until he or she is able to pass stool through the anus.
• You will be taught how to care for the stoma at home.
• You will be taught how to keep your child from touching the incision.
• You may be instructed to stretch (dilate) your child’s anus with a tool called a dilator.
• If your child is of driving age, do not let him or her drive for 24 hours if he or she was given a sedative.

Summary

• Perineal anoplasty is a surgery that may be done to treat imperforate anus, a condition where the anus is missing, blocked, or in the wrong place.
• A piece of your child’s colon may be redirected (diverted) to an opening in the abdomen (stoma). This process, known as colostomy, will divert stool to a bag outside the body. A colostomy may be temporary.
• You will be taught how to care for the incision and stoma at home.

Care After Perineal Anoplasty

Here is the information about how to care for your child after his or her procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your child’s health care provider.

What can I expect after the Perineal Anoplasty procedure?

After your child’s procedure, it is common for your child to have:

• Pain.
• Frequent bowel movements.
• Constipation.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines, including stool softeners, only as told by your health care provider.
• Give your child antibiotic medicine as told by your child’s health care provider. Do not stop giving the antibiotic even if your child starts to feel better.
• If your child has a severe diaper rash, contact your health care provider and ask him or her to recommend a cream. Then, apply the cream around the anal area several times a day.
• Do not give your child aspirin because of the association with Reye syndrome.
• If your child is of driving age, do not let him or her drive for 24 hours if he or she was given a medicine to help him or her relax for the procedure (sedative).

What is the Diet to be followed after Perineal Anoplasty?

• Follow any diet instructions that your child’s health care provider has given.
• If possible, begin breastfeeding your child as soon as possible. This can help with constipation.
• Find out if there are any foods or drinks that you should avoid giving your child. The goal is to keep bowel movements soft.

Incision care

• Follow instructions from your health care provider about how to take care of your child’s incision.
• Clean the incision and the surrounding skin after your child has a bowel movement.
• Check your child’s incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

General instructions

• Restrict your child’s activity as told by your child’s health care provider.
• If you were instructed to stretch (dilate) the anus with a tool called a dilator, do so as told by your child’s health care provider. Using the dilator will help the anus stay open.
• If your child had a colostomy as part of the procedure, follow instructions from your child’s health care provider about how to care for it.
• Ask your child’s health care providers for suggestions about how to potty train your child. Your child may need extra help, and your child may take longer than normal to potty train.
• Keep track of your child’s stools and bowel movement patterns. This will help your child’s health care provider understand whether there is a complication from surgery.

Contact a health care provider if:

• Your child has trouble passing urine or having a bowel movement.
• Your child vomits or has no appetite, and this lasts for more than 2 days after the surgery.
• Your child seems to be in pain, even after pain medicine is given.
• Your child stops gaining weight and growing.
• There is more redness, swelling, or pain around your child’s incision.
• There is more fluid or blood coming from your child’s incision.
• Your child’s incision feels warm to the touch.
• There is pus or a bad smell coming from your child’s incision.
• Your child has severe diaper rash.