Transabdominal and perineal anoplasty

Transabdominal and 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 and urethra Indication (1) high or combined rectal urethral fistula, rectal vaginal fistula. (2) Middle or low malformation or combined with rectal urethral fistula, rectal vaginal fistula, rectal vestibular fistula and so on. 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: lithotomy position. The incision in the left lower abdomen is 8 cm long. 2. Cut the peritoneum: After entering the abdominal cavity, lift the sigmoid colon, cut the peritoneum on both sides of the rectum, find the ureter on both sides and protect the band. The rectal bladder peritoneal reflex was cut in the anterior side of the rectum. 3. Separation of the rectum: The rectum is separated by the rectal wall, and the fingers are bluntly separated in the rectal posterior space between the rectum and the pelvic wall fascia to avoid damage to the anterior venous plexus and massive bleeding. After separation, the rectal space was blocked with a hot saline gauze pad and pressed to stop bleeding. After the separation is completed, the rectum can be dragged to the anus without tension. If the blood vessels are tight and the difficulty is dragged, the rectal blood vessels can be ligated and cut. 4. Ligation of the fistula: If the fistula is combined, it should be carefully separated, and it should be sewed slightly away from the bladder to cut off the fistula. 5. Mark the rectum: the left and right sides of the lower end of the rectum are marked with black and white lines. 6. Cut the meeting Yin: The surgeon turns to the perineal operation. The skin of the anus is longitudinally cut 1.5cm. 7. Pull out the rectum: separate the hemostatic forceps in the center of the external sphincter and straight up through the puborectal muscle ring to the blind end of the rectum. Pull the rectum to the perineal incision and press the black and white line to prevent distortion. 8. Anal shaping: resection of the rectal blind end and fistula, suture the rectal pulp muscle layer and the anal subcutaneous suture, the entire line of tangential and skin suture. After the rectum, a rubber sheet is placed for drainage. 9. Close the abdominal cavity: suture the pelvic peritoneum and posterior peritoneum, suture the incision layer by layer. complication 1. Anal stenosis is more common. Mainly due to the perineal incision is too small, anastomotic opening, infection, scar formation. The method of prevention is to completely free the rectum, so that the anastomosis is tension-free and the rectal blood circulation is maintained. Regular anal expansion began 2 weeks after surgery. If the stenosis is serious, plastic surgery is required. 2. The common cause of anal incontinence is excessive scarring, followed by damage to the anal sphincter and pelvic plexus. 3. Rectal mucosal prolapse due to too long rectum or excessive anal opening. 4. Urethral stricture due to urethral injury during surgery.