transperineal anoplasty

Perineal anal angioplasty 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: anal trauma Indication Perineal surgery (1) Anal membranous atresia is suitable for ten-shaped incision anusplasty. (2) Anal stenosis is suitable for Z-shaped anal angioplasty. (3) Perineal anal angioplasty adapts to the low position of the rectal blind end below the PC line, such as anal skin spasm, anal vestibular fistula and so on. 2. Colostomy (1) All kinds of medium and high deformities are generally poor and cannot tolerate other operators. (2) Those with moderate or high deformity without fistula should first undergo colostomy, and then undergo radical surgery six months later. 3. Abdominal perineal anusplasty (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. 4. perineal anusplasty: (1) High, medium or combined sputum. (2) Low-level combined sputum. Contraindications Aged and debilitated, the important organs of the heart, lungs and other functions are poor. 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. Make a longitudinal incision at the anal point of 1.5 to 2.0 cm. 2. Reveal the rectal blind end: separate the subcutaneous tissue, and the longitudinal external sphincter fibers can be seen in the deep part of the incision. The upper part of the muscle fiber is separated upwards, and the rectal blind end of the conical blue color can be seen. 3. Separation of the rectal blind end: Dispose of the traction line at the blind end at 3, 6, 9, and 12 for traction. The blunt, sharp combination of the blind end is separated, and the urethral catheter in the urethra is touched to prevent damage. 4. Pull out the rectum: separate the blind end of the rectum by more than 5cm, so that it can be pulled out from the external sphincter under tension without tension, and the subcutaneous muscle layer can be sutured and fixed. 5. Stitching: Cut the blind end to absorb meconium and block with cotton balls to avoid meconium overflow. The long part of the intestinal wall was removed, and the intestinal wall was sutured intermittently with the skin. Leave a soft hose in the anus. After separating the subcutaneous and anal sphincters from the fistula, the puborectalis muscle was pushed open. The two side walls and the posterior wall of the rectum were lightly separated. The catheter was used as a marker to separate the fistula and the anterior wall of the rectum. After the separation is completed, the proximal end of the fistula is ligated and the fistula is turned out from the distal end. The separated rectum is then pulled out so that the rectal end of the fistula and the distal end of the suture are interlaced. complication 1. Mucosal prolapse is the most common complication. Local resection or circular resection can be performed according to prolapse. 2. Anal stenosis. Persistence of anal expansion is the best way to prevent stenosis. For severe stenosis, Z-shaped surgery can be performed to enlarge the anus.