Anorectal malformation

Regardless of the type of malformation, 100% of patients require an assessment by a pediatric surgeon who will determine the appropriate surgical treatment based on the patient's physical examination and general condition.

The most frequently performed treatments are :

• colostomyA stoma (artificial opening) is created that temporarily diverts the colon to the abdominal wall so that the patient can evacuate until the time of the definitive reconstruction.
• AnoplastyDefinitive repair in these patients is scheduled between 4 and 6 months of age. The most commonly used surgical technique is the posterior sagittal anorectoplastyIn this procedure, an incision is made in the midline between the buttocks to identify the muscle complex (the sphincter) and place the "new anus" in the center of it to maximize the possibility of continence.

Once the patient has recovered from the procedure and the anoplasty has healed properly, the colostomy will be closed, approximately 2-3 months after the anorectoplasty.

In some cases (not all), parents may need to dilate the anoplasty at home until the colostomy is closed. This is done to prevent the newly reconstructed anus from narrowing due to the physiological healing process.

1. Primary anoplastyThis type of intervention is reserved for the most severe malformations. mild or low which allow for definitive repair in the neonatal period without the need for a colostomy.

Monitoring and forecasting

All patients with anorectal malformation require long-term follow-up as they may develop constipation or fecal incontinence from an early age:

Constipation in these patients can paradoxically manifest itself with multiple small bowel movements , which is known as encopresis or overflow incontinence.

It requires aggressive treatment with laxatives to prevent future complications due to the dilation and accumulation of stool in the rectal ampulla, causing what is known as a "megarectum." The most commonly used laxatives are stimulant laxatives to promote colonic motility, along with fiber to increase stool volume and consistency.

Fecal incontinence in acute renal failure (ARF) is present in patients with "high" malformations, such as rectovesical fistula or long canal cloacas, or in patients with spinal cord malformations, such as tethered cord. This incontinence can be treated with intestinal transit slowers or with retrograde (rectal) or antegrade (appendicostomy) enemas .

There are several developmental milestones that are very important in monitoring patients with AMR. These are the age approaching bowel and bladder control, which is later in children with AMR, between 2 and 5 years of age, and adolescence.

Due to the wide variety of ARM types and associated anomalies, these patients should be evaluated by pediatric surgeons and urologists specializing in these types of diseases to ensure appropriate treatment and minimize the impact on quality of life.