Imperforate anus repair

Description:
Surgical repair involves creating an opening for passage of stool. Complete absence of an anal opening requires emergency surgery for the newborn.

Surgical repairs are done while the baby is deep asleep and pain-free (using general anesthesia).

Surgery for a high type imperforate anus defect usually involves creation of a temporary opening of the large intestine (colon) onto the abdomen to allow passage of stool (this is called a colostomy ). The baby is allowed to grow for several months before attempting the more complex anal repair.

The anal repair involves an abdominal incision, loosening the colon from its attachments in the abdomen to allow it to be repositioned. Through an anal incision, the rectal pouch is pulled down into place, and the anal opening is completed. The colostomy may be closed during this stage or may be left in place for a few more months and closed at a later stage.

Surgery for the low type imperforate anus (which frequently includes a fistula ) involves closure of the fistula, creation of an anal opening, and repositioning the rectal pouch into the anal opening.

A major challenge for either type of defect and repair is finding, using, or creating adequate nerve and muscle structures around the rectum and anus to provide the child with the capacity for bowel control.

Indications:
This surgery is recommended to repair cases of imperforate anus and other anorectal malformations .

What to Expect After:
Most anorectal malformations can be corrected successfully with surgery. Normal bowel function can be established in most cases. The long-term prognosis is excellent if no other pelvic abnormalities are found.

Convalescence:
The child may require several days in the hospital. Dilatation of the new anus (to improve muscle tone and prevent narrowing) will begin in the hospital and continue for some months. Stool softeners and a high-residue diet will need to continue throughout childhood.

Risks:
Risks for any anesthesia are:

Risks for any surgery are:

Other risks include:

Costs:
The costs of any surgery varies significantly between surgeons, medical facilities, and regions of the country. Patients who need more extensive surgery will require more intensive and expensive treatment.

Surgery charges can be separated into five parts: 1) the surgeon's fee, 2) the anesthesiologist's fee, 3) the hospital charges, which includes nursing care and the operating room, 4) the medications, and 5) additional charges.

1. Surgeon's fee: averages $1,500 to $3,000
2. Anesthesiologist's fee: averages $350 to $400 per hour
3. Hospital charges: basic rate averages $1,500 to $1,800 per day (more for the intensive care unit (ICU) or private rooms)
4. Medication charges: $200 to $400
5. Additional charges: assisting surgeon, treatment of complications, diagnostic procedures (such as blood or X-ray exams), medical supplies, or equipment use.

Insurance coverage for surgery expenses depends on many factors and should be explored for each individual instance.