Malformasi Anorektal. ANGKA KEBERHASILAN POSTEROSAGITTAL ANORECTOPLASTY (PSARP) YANG DINILAI DARI SKOR KLOTZ PADA PASIEN MALFORMASI ANOREKTAL. Faktor Risiko yang Memengaruhi Luaran Klinis Malformasi Anorektal pada Neonatus di RSUD Dr. Zainoel Abidin, Banda Aceh. Article. Full-text available.

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Anorectal malformations

Laparoscopically assisted anorectal pull-through for high imperforate anus — a new technique. It is also the most important problem to avoid after definitive repair for female patients with rectovestibular or rectoperineal fistula and for male patients with rectobulbarurethral fistula, imperforate anus without fistula, and rectoperineal fistula. The surgical approach to repairing these defects changed dramatically in with the introduction of the posterior sagittal approach, which allowed surgeons to view the anatomy of these defects clearly, to repair them under direct vision, and to learn about the complex anatomic arrangement of the junction of rectum and genitourinary tract [ 1 – 6 ].

In cases of rectovestibular fistula, the posterior sagittal incision can be shorter than in male patients with anorfktal fistulae. Diagnostic methods The radiologic evaluation of a newborn with imperforate anus includes an abdominal ultrasound to evaluate for urologic anomalies. Careful, regular follow-up is necessary in these patients to accurately reassess their prognosis and to avoid problems, which can dramatically impact on their ultimate functional result.

First; are there associated anomalies that threaten the baby’s life and should be dealt with right away? Male newborns with recto-perineal fistula do not need a colostomy.

The surgeon must be prepared to perform a urologic diversion if necessary. Patients with these anomalies also have small genitalia.

The surgeon must be prepared to open the bladder and to reimplant the ureters if necessary. The operation is called a “minimal posterior sagittal anoplasty”.

These babies should undergo colostomy at birth, and then their definitive repair involves a posterior sagittal approach and an end-to-end anastomosis between the upper rectal pouch and the anal canal. In the case of persistent cloaca, a distended vagina hydrocolpos can be identified.


A child with a normal bowel movement pattern is trainable, whereas a child with the second pattern will likely need a bowel management program. Operative Management of Anomalies in Male. This voluntary contraction occurs only in the minutes prior to defecation, and these muscles are used only occasionally during the rest of the day and night.

The proximal stoma is connected to the upper gastrointestinal tract and drains stool. Meconium is usually not seen at the perineum in a baby with a recto-perineal fistula until at least 16—24 hours.

OEIS Omphalocele, exstrophy, imperforate anus, and spinal defects. If the air column is greater than 1 cm from the perineum, a colostomy is indicated. Such children need supervision to avoid fecal impaction, constipation, and soiling. In this case, during the main repair, the surgeon knows that the rectum will be found only through the abdomen, and a combined posterior sagittal and abdominal or laparoscopic approach is employed.

Perineal fistulas in both male and female have traditionally been called “low” defects.

Anorectal malformations

A short 1—2 cm midsagittal incision is made posterior to the fistula site, dividing the entire external sphincter complex. The intraabdominal pressure must be high enough to overcome the tone malformais the muscles that surround the rectum if one expects to see meconium at the perineum or in the urine.

Perianal dissection towards the laparoscopic light source favours accurate placement of a trocar to pull makformasi rectum through the external sphincter muscle complex. As discussed previously, the surgeon must decide in the newborn period whether the child requires fecal diversion with a colostomy, or can undergo a primary repair procedure. When a patient with a megasigmoid has been shown to be fecally continent, resection of the sigmoid has been found to dramatically reduce the patient’s laxative requirements.

Unfortunately this left many patients incontinent and was not an appropriate solution to the spectrum of malformations. Pena A, Levitt M. If adslah baby growing well, the repair can be performed at 1—2 months of age.


The early management of a newborn infant born with an anorectal anomaly is crucial and two important questions must be answered during the first 24 to 48 hours of life. Patients like this are often referred with “fecal incontinence. The surgeon may not be able to find the rectum and may find and damage other, unexpected, structures, such as the posterior urethra, seminal vesicles, vas deferens, and ectopic ureters during the search for the rectum. Depending on the amount of colon resected, the patient may have loose stools.

A cross-table lateral x-ray should be performed, and will help determine the need for a colostomy. Published online Jul This study is vital in determining the anatomy so anorrektal definitive repair can be planned. The radiologic evaluation of a newborn with imperforate anus includes an abdominal ultrasound to evaluate for urologic anomalies. Untethering of the cord adzlah indicated in the neurosurgical literature to avoid motor and sensory problems. The cloaca itself represents a spectrum and certainly defies the classification “high”, “intermediate”, and “low”.

After the baby is born, an intravenous malformasl is placed anoretkal fluids and antibiotics, and a nasogastric tube is inserted to keep the stomach decompressed to avoid the risk of vomiting and aspiration. Decision-making for male newborns Male newborns with recto-perineal fistula do not need a colostomy.

Non-syndromic ARM malformmasi fistula.

Pitfalls in the management of newborn cloacas. Urinary control varies based on the length of the common channel. Once the constipation is managed, they become continent.