Transsacral perineal anoplasty

Perineal perineal anusplasty is a congenital anorectal malformation surgery. The choice of the method depends on the type of malformation. The choice of operation time is determined by the combination of fistula or not. Treatment of diseases: rectal vaginal fistula congenital rectal anal deformity Indication (1) High, medium or combined sputum. (2) Low-level combined sputum. Contraindications If the person is too old, the person with poor general condition should be filled. Preoperative preparation 1. Take the inverted pelvic lateral slice, determine the type of rectal anal deformity from the position of the full rectal blind end, and determine the operation time and operation mode. It is determined according to the relative position of the rectal blind end to the PC line and the I line. (1) The newborn needs to be 12 to 24 hours after birth, and the gas to be swallowed reaches the rectal poster. (2) Stand upside down for 1 to 2 minutes, press the abdomen to let the air enter the blind end. (3) Anal point labeling. (4) Taking X-ray films centered on the pubic symphysis. 2. Place the catheter before surgery as a sign to protect the urethra when separating the rectum. 3. Correct water and electrolyte imbalance before surgery. Prepare blood 200 to 400ml. Fasting 12 hours before surgery. 4. Place the stomach tube. 5. On the 1st day before surgery, ampicillin, 50mg ~ 100mg / kg, intravenous drip. 6. Clean the enema before surgery (through the fistula). 7. Inject 1% neomycin solution 3ml/kg from the fistula 12 hours before surgery. 8. 1 hour before surgery, intramuscular injection of luminal 2mg ~ 4mg / kg, subcutaneous injection of atropine 0.01mg ~ 0.02mg / kg. Surgical procedure 1. Position, incision: chest or knee or right lateral position, back forward, hip pad high. The anus was made into a ten-shaped incision, and the tail was made into a 4 to 5 cm long incision. The lower end of the incision was 1 cm from the anal margin. 2. Separate the rectum and fistula: cut the skin, subcutaneous tissue, and cut the anal fascia. Cross the appendix joint or use the tissue forceps to lift the tailbone up and find the rectum (for ease of searching, insert the anal canal from the mouth into the blind end of the rectum), and separate the posterior, lateral and anterior wall of the rectum. Carefully separate the fistula, pull the rectum to one side, touch the catheter in the urethra, identify the puborectalis muscle after the urethra, pick up the muscle with a right angle clamp and expand it. 3. Ligation of the fistula: If the fistula is tightly attached to the urethra, it is not easy to separate. The blind end of the rectum can be cut, the fistula can be found in the intestine, and the separation can be carried out, then separated, sutured and cut. 4. Pull out the rectum: Through the perineal incision, a tunnel is separated between the center of the external sphincter and the puborectal muscle ring, and the rectum is pulled out of the tunnel. The blind end of the rectum and the fistula were removed, and the sarcolemma and subcutaneous tissue at the end of the rectum were sutured intermittently. The full thickness of the rectal margin was sutured intermittently with the skin. Complete anal shaping. 5. Suture incision: After the rectum, the rubber sheet is placed for drainage, and the buttocks are taken out from the other side. The anal fascia, subcutaneous tissue and skin are sutured layer by layer. complication 1. Anal stenosis; 2. Anal incontinence.