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Anorectal malformationAAnorectal malformationAnorectal malformationEnglishGastrointestinalNewborn (0-28 days);Baby (1-12 months)RectumRectum;AnusProceduresCaregivers Adult (19+)NA2013-11-08T05:00:00ZKimberly Colapinto RN (EC), MN, CETN(C);Sharifa Himidan MD10.000000000000059.00000000000001436.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn what treatment is available if your child is diagnosed with anorectal malformation.</p><h2>What is an anorectal malformation?</h2><p>An anorectal malformation is a birth defect that causes the anus not to develop properly. It occurs in one in every 4,000 babies.<br></p> <figure class="asset-c-80"> <span class="asset-image-title">Anorectal malformation in boys</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_anorectal_malformation_male_EN.png" alt="Cross-section of normal pelvis in a boy and cross-section of pelvis with rectum connected to urethra and no anal opening" /> <figcaption class="asset-image-caption">In boys, anorectal malformation can happen when the rectum does not separate properly from the urinary system.</figcaption> </figure> <p>Some children are born with an anal opening that is too small, some have an anal opening that is in the wrong place and some have no anal opening at all. This can happen if the end of the intestine does not separate properly from your child's urinary system (in boys) or their vagina (in girls) while they are still in the womb.<br></p><p>A child who is born with an anorectal malformation might also have problems in other areas of their body. Your doctor will do tests to check for these problems soon after your child is diagnosed.</p> <figure class="asset-c-80"> <span class="asset-image-title">Anorectal malformation in girls</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_anorectal_malformation_female_EN.png" alt="Cross-section of normal pelvis in a girl and cross-section of pelvis with anus abnormally close to vagina" /> <figcaption class="asset-image-caption">In girls, anorectal malformation can happen when the rectum does not separate properly from the vagina. This causes the anus to be much closer to the vagina then it normally should be.</figcaption> </figure><h2>Key points</h2> <ul> <li>Anorectal malformation is a birth defect that causes a child to have an anal opening that is too small, an anal opening in the wrong place or no anal opening at all.</li> <li>Depending on your child's condition, the surgeon might dilate (stretch) their anus if it is too small or perform surgery to move the anus to the right place or create a new anus.</li> <li>After surgery, call your surgeon's office if your child has a <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=30&language=English">fever</a>, is <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=746&language=English">vomiting</a>, has redness or swelling around their incisions or has more frequent or less frequent bowel movements than they normally have.</li> <li>Your child may have lifelong problems with bowel control or constipation. Your surgeon will only know this by following your child closely until they finish toilet training and later into their childhood and adolescence.</li> </ul><h2>Taking care of your child at home</h2><ul><li>Give your child a bath every day.</li><li>After the anoplasty or anorectoplasty you will see stitches around your child's new anus. Place an antibiotic cream on top of the stitches (do not rub it in) three times a day until you see the doctor in follow up.</li><li>Do not put anything into your child's bottom (for example a temperature probe) until your doctor tells you it is okay to do so.</li><li>Bring your child for follow-up appointments and follow any special care instructions.</li><li>To prevent <a href="/article?contentid=26&language=English">diaper rash</a>, apply ointments or creams to your child's bottom when they first start stooling from their anus.</li></ul><h2>When to call the surgery team</h2> <p>Call your surgeon's office if:</p> <ul> <li>your child has a <a href="/Article?contentid=30&language=English">fever</a> of 38°C (100°F) or higher</li> <li>your child is in pain<br></li> <li>your child is <a href="/Article?contentid=746&language=English">vomiting</a> (throwing up)</li> <li>your child has more frequent or less frequent bowel movements than they normally have</li> <li>your child has a swollen belly or serious diaper rash</li> <li>there is redness or swelling around the incisions</li> <li>there is no stool from the stoma</li> <li>the stoma is retracted (pulled back inside the skin) or prolapsed (coming out too far from the skin)</li> <li>the stoma is bleeding.</li> </ul> <p>You can also call if you have any other concerns about your child.</p><h2>How anorectal malformation is repaired</h2> <p>Your child may need surgery (an operation) to repair the malformation.</p> <h3>If the opening is too small</h3> <p>If the anal opening is in the right place but is simply too small, the doctor may only need to use a special dilator to slowly stretch it to make it the right size.</p> <h3>If the opening is in the wrong place</h3> <p>If the opening is in the wrong place, the surgeon may perform a surgery called anoplasty (see below) to put the anus in the right place.</p> <h3>If there is no opening or if the opening is far away from where it should be</h3> <p>If your child's anal opening is very far from where it should be, or if there is no opening at all, the doctor will need to create an ostomy for your child within 24 to 48 hours of birth.</p> <p>When your child is a little older, they will normally have a posterior sagittal anorectoplasty (PSARP), or Peña procedure, to create the anus in the right place. This is explained below.</p><h2>During the surgery</h2> <p>If your child needs an ostomy, anoplasty or anorectoplasty, they will have a special "sleep medicine" called a general anaesthetic. This means that your child goes to sleep and does not feel any pain during the operation.</p> <h3>Ostomy</h3> <p>An ostomy is an opening created from the inside of the body to the outside, on the tummy (abdomen). Stool passes through it and is collected in a pouch that is attached to your child's abdomen. In most cases, this ostomy is only temporary.</p> <p>Once your child has an ostomy, they will be like any other baby except that they will stool into the pouch. Before you leave the hospital, your health-care team will teach you how to care for your child's ostomy and when to call the doctor.</p> <h3>Anoplasty</h3> <p>This usually involves gently stretching your child's anal opening over several months and then performing surgery to move the anus when your child is older, before they start solid food.</p> <h3>Posterior sagittal anorectoplasty</h3> <p>A posterior sagittal anorectoplasty usually involves disconnecting the end of the intestine from the urinary system (for boys) or from the vagina or beside the vagina (for girls). An opening is then created to allow stool to come out of the intestine at the right place.</p> <p>If the connection was very high, the surgeon will sometimes do some of the surgery through your child's abdomen. This is usually done with a <a href="/Article?contentid=1005&language=English">laparoscope</a> (a small camera inserted through your child's belly button) and requires only tiny incisions (surgical cuts).</p><h2>After the surgery</h2><p>Your child can go home when:</p><ul><li>their heart rate, breathing, blood pressure and temperature are normal</li><li>they can eat without <a href="/Article?contentid=746&language=English">vomiting</a> (throwing up)</li><li>they are comfortable taking oral <a>pain medicine</a> (medicine taken by mouth)</li><li>the stoma is working well</li><li>your child's doctors and nurses have finished teaching you how to care for your child after surgery.</li></ul><h3>Follow-ups with the surgeon</h3><p>Your child will have their first follow-up with the surgeon two to three weeks after the anoplasty or anorectoplasty. It is very important that you attend this follow-up appointment when it is scheduled.</p><p>The surgeon will check your child and make sure that the stitches at the anus are healing properly. They will do this either by inserting their finger or using an instrument called a Hegar dilator. You may need to buy the Hegar dilator (it is not expensive).</p><h3>Dilations after surgery<br></h3><p>The surgeon may bring your child back for rectal calibration (gentle stretching of the new anus) with a finger or Hegar dilator or will teach you how to do it at home. Your child may need these dilations for several months after surgery. It is very important for your child's care that you meet with your surgeon and follow their instructions. If the anus does not heal properly, your child may need more surgery.</p><h3>When your child can start stooling normally</h3><p>When your surgeon is sure that your child has fully healed from the anoplasty or anorectoplasty, they will perform another operation to close your child's ostomy.</p><p>Your child will then start stooling from their anus and have many stools a day. As your child's bottom has never had stool on it before, they will be prone to <a href="/Article?contentid=26&language=English">diaper rash</a>. The nurse will teach you how to apply special ointments or creams to your child's bottom before you bring your baby home from hospital.</p><h2>Further information:</h2> <p><a href="http://www.sickkids.ca/pdfs/Good2Go%20Transition%20Program/38906-Anorectal%20Timeline-Handout.pdf" target="_blank">SickKids Good 2 Go Anorectal Malformation Timeline</a></p><h2>​Sources</h2> <p>American Pediatric Surgical Nurses Association. <a target="_blank" href="http://www.apsna.org/?page=TeachingMaterials">Posterior Sagital Anorectoplasty - PSARP (Pena procedure) Teaching Sheet</a></p>
Malformation anorectaleMMalformation anorectaleAnorectal malformationFrenchGastrointestinalNewborn (0-28 days);Baby (1-12 months)RectumRectum;AnusProceduresCaregivers Adult (19+)NA2013-11-08T05:00:00ZKimberly Colapinto RN (EC), MN, CETN(C);Sharifa Himidan MD10.000000000000059.00000000000001436.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Apprenez quels sont les traitements possibles lorsqu’une malformation anorectale est diagnostiquée chez votre enfant.</p><h2>En quoi consiste une malformatio​n anorectale?</h2><p>Une malformation anorectale est une déficience congénitale qui se manifeste par le développement anormal de l’anus. Son incidence est d’un cas pour 4000 nouveau-nés.</p> <figure class="asset-c-80"><span class="asset-image-title">Malformation anorectale chez les garçons</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_anorectal_malformation_male_FR.png" alt="Coupes transversales d’un bassin normal mâle et d’un bassin avec l’absence d’orifice anal et le rectum raccordé à l’urètre" /><figcaption class="asset-image-caption">Chez les garçons, des malformations anorectales peuvent se produire quand le rectum ne se sépare pas correctement de l'appareil urinaire.</figcaption> </figure> <p>À la naissance, l’orifice anal est soit trop petit, n’est pas dans sa position normale ou n’est pas perforé chez certains bébés. Ces malformations surviennent pendant la grossesse lorsque l’extrémité de l’intestin ne se sépare pas correctement de l’appareil urinaire (chez les garçons) ou du vagin (chez les filles).</p><p>Les malformations anorectales peuvent aussi être accompagnées d’autres problèmes physiques. Votre médecin fera subir des examens à votre bébé pour les déceler peu après avoir posé son diagnostic.</p> <figure class="asset-c-80"><span class="asset-image-title">Malformation anorectale chez les filles</span><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_anorectal_malformation_female_FR.png" alt="Coupe transversales d’un bassin normal féminin et d’un bassin avec l’anus anormalement proche du vagin" /><figcaption class="asset-image-caption">Chez les filles, des malformations anorectales peuvent se produire quand le rectum ne se sépare pas correctement du vagin. L'anus est alors beaucoup trop proche du vagin qu'il devrait l'être en temps normal.</figcaption> </figure> <br><h2>À r​etenir</h2> <ul> <li>Une malformation anorectale est une déficience congénitale caractérisée par un orifice anal qui est trop petit, qui n’est pas dans sa position normale ou n’est pas perforé.</li> <li>Selon le type de malformation dont est atteint votre enfant, le chirurgien pourra dilater l’anus (l’étirer) ou effectuer une chirurgie pour le placer dans sa position normale ou encore en créer un nouveau.</li> <li>Après la chirurgie, téléphonez au bureau du chirurgien si votre enfant a de la fièvre, vomit ou évacue plus ou moins de selles ou si vous observez une rougeur ou une enflure dans la région environnante de ses incisions.</li> <li>Votre enfant éprouvera peut être des problèmes d’incontinence ou de constipation tout au long de sa vie. Le chirurgien ne pourra le déterminer qu’en suivant votre enfant de près pendant tout le processus d’apprentissage de la propreté et, plus tard, durant l’enfance et l’adolescence.</li> </ul><h2>Soins à​ prodiguer à votre enfant à la maison</h2> <ul> <li>Baignez votre enfant tous les jours.</li> <li>Vous observerez des points de suture autour de l’anus de votre enfant suivant l’anoplastie ou l’anorectoplastie.</li> <li>Appliquez une crème antibiotique à leur surface (sans la faire pénétrer) 3 fois par jour jusqu’au premier rendez vous de suivi avec le chirurgien.</li> <li>N’introduisez rien dans l’anus de votre enfant (n’y insérez pas de thermomètre, par exemple) avant que le chirurgien vous autorise à le faire.</li> <li>Respectez les rendez vous de suivi de votre enfant et respectez toute instruction concernant l’administration de soins particuliers.</li> <li>Appliquez des onguents ou des crèmes sur le siège de votre enfant lorsqu’il commencera à évacuer ses selles par l’anus afin d’éviter les érythèmes fessiers.</li></ul><h2>Dans quelles situations vous devez téléphoner à l’équipe de chirurgie</h2> <p>Téléphonez au bureau du chirurgien quand :</p> <ul> <li>votre enfant a une fièvre de 38,5°C (100,5 °F) ou plus,</li> <li>votre enfant éprouve des douleurs,</li> <li>votre enfant vomit,</li> <li>votre enfant évacue plus ou moins de selles qu’à la normale,</li> <li>votre enfant a le ventre gonflé et un érythème fessier grave,</li> <li>vous observez une rougeur ou une enflure dans la région environnante des incisions,</li> <li>aucune selle n’est évacuée par la stomie,</li> <li>la stomie est rétractée (sous le niveau de la peau) ou présente un prolapsus (forme une protubérance trop proéminente par rapport au niveau de la peau),</li> <li>du sang s’écoule de la stomie.</li> </ul> <p>Vous pouvez aussi téléphoner au bureau du chirurgien si vous avez d’autres préoccupations au sujet de votre enfant.</p><h2>Comme​nt les malformations anorectales sont elles corrigées?</h2> <p>Il se peut que votre enfant ait besoin d’une intervention chirurgicale afin de corriger la malformation.</p> <h3>Quand l’orifice ​est trop petit</h3> <p>Quand l’orifice de l’anus est dans sa position normale, mais qu’il est simplement trop petit, le médecin peut n’avoir qu’à utiliser un dilatateur spécial pour l’agrandir lentement jusqu’à ce qu’il ait une taille appropriée.</p> <h3>Quand l’or​ifice n’est pas dans sa position normale</h3> <p>Quand l’anus n’est pas dans sa position normale, le chirurgien peut effectuer une chirurgie nommée anoplastie (voir ci dessous) pour déplacer l’anus à l’emplacement approprié.</p> <h3>Quand l’anus est imperfor​é ou est très éloigné de sa position normale</h3> <p>Si l’anus de votre bébé est très éloigné de son emplacement normal ou n’est pas perforé, le médecin devra pratiquer une stomie dans les 24 à 48 heures suivant la naissance.</p> <p>Quand votre enfant sera un peu plus vieux, il devra aussi normalement subir une anorectoplastie sagittale postérieure (ARPSP) ou procédure de Peña afin de créer un anus au bon endroit. Cette intervention est expliquée ci-dessous.</p><h2>Pendant la chir​​urgie</h2> <p>Si votre enfant doit subir une ostomie, une anoplastie ou une anorectoplastie, on pratiquera une anesthésie générale qui consiste à administrer un anesthésiant qui est un « médicament spécial qui le fera dormir ». L’anesthésiant permet également de faire en sorte que votre enfant ne ressente aucune douleur pendant l’intervention.</p> <h3>Ostom​ie</h3> <p>Une ostomie consiste à pratiquer une ouverture appelée stomie à l’intérieur du ventre (abdomen) qui communiquera avec l’extérieur. Les selles y seront évacuées dans un sac fixé sur l’abdomen de votre enfant. Dans la plupart des cas, les stomies ne sont que provisoires.</p> <p>Après avoir subi une ostomie, votre enfant sera comme tous les autres bébés, sauf qu’il évacuera ses selles dans le sac qu’il portera. Avant de quitter l’hôpital, l’équipe médicale vous montrera les soins à apporter à la stomie de votre bébé et vous expliquera dans quelles situations vous devrez téléphoner au médecin.</p> <h3>Ano​plastie</h3> <p>L’anoplastie consiste habituellement à étirer doucement l’orifice anal de votre enfant durant plusieurs mois, puis, quand il sera plus âgé, à lui faire subir cette opération afin de déplacer son anus avant qu’il ne commence à manger des aliments solides.</p> <h3>Anorectoplastie s​agittale postérieure</h3> <p>Une anorectoplastie sagittale postérieure consiste habituellement à détacher l’extrémité de l’intestin de l’appareil urinaire (chez les garçons) ou du vagin ou de la région adjacente (chez les filles). Le chirurgien pratique ensuite une ouverture pour permettre aux selles d’être évacuées des intestins au bon endroit.</p> <p>Si la communication entre les organes est placée très haut, le chirurgien effectue parfois une partie de l’intervention en passant par l’abdomen. Ces étapes sont habituellement réalisées par <a href="/Article?contentid=1005&language=French">laparoscopie</a> (une petite caméra est alors insérée dans l’abdomen par le nombril) qui n’exige que de minuscules incisions (coupures chirurgicales).</p><h2>Après la c​​hirurgie</h2> <p>Votre enfant pourra rentrer à la maison, quand :</p> <ul> <li>son rythme cardiaque, sa respiration, sa tension artérielle et sa température seront normaux,</li> <li>il pourra manger sans <a href="/Article?contentid=746&language=French">vomir</a>,</li> <li>il acceptera volontiers de prendre un médicament anti-douleur par voie orale (par la bouche),</li> <li>la stomie fonctionnera correctement,</li> <li>le médecin et les infirmiers de votre enfant vous auront enseigné tous les soins que vous devrez lui apporter après la chirurgie.</li> </ul> <h3>Suivis p​ar le chirurgien</h3> <p>Votre enfant aura son premier rendez vous de suivi avec le chirurgien 2 ou 3 semaines suivant l’anoplastie ou l’anorectoplastie. Il est important que vous vous présentiez à ce rendez vous avec votre enfant au moment fixé.</p> <p>Le chirurgien examinera votre enfant pour s’assurer que la suture à l’anus guérit bien. Pour ce faire, il insérera un doigt ou un instrument nommé dilatateur Hegar dans l’anus. Vous devrez peut être acheter ce dernier (à un prix modique).</p> <h3>Dilatations suivant la ch​irurgie</h3> <p>Le chirurgien peut revoir votre enfant pour dilater le nouvel anus (léger étirement) à l’aide d’un doigt ou d’un dilatateur Hegar ou vous montrera comment le faire à la maison. Il se peut que votre enfant ait besoin de dilatations anales durant plusieurs mois suivant la chirurgie. Il est crucial que vous rencontriez le chirurgien et que vous suiviez ses instructions. Si l’anus ne guérit pas correctement, une autre opération de chirurgie peut être requise.</p> <h3>Moment o​ù votre enfant pourra aller à la selle normalement</h3> <p>Quand le chirurgien est certain que les plaies de l’anoplastie ou de l’anorectoplastie ont entièrement guéri, il procédera à une autre intervention afin de fermer la stomie de votre enfant.</p> <p>Celui-ci commencera alors à évacuer ses selles par l’anus de nombreuses fois par jour. Comme le fessier de votre enfant n’aura jusqu’alors jamais été en contact avec des selles, il sera sujet à de graves <a href="/Article?contentid=26&language=French">érythèmes fessiers​</a> (éruption cutanée). Un infirmier vous montrera comment y appliquer des onguents ou des crèmes spéciales avant de ramener votre bébé à la maison suivant son hospitalisation.</p><h2>Further information:</h2> <p><a href="http://www.sickkids.ca/pdfs/Good2Go%20Transition%20Program/38906-Anorectal%20Timeline-Handout.pdf" target="_blank">SickKids Good 2 Go Anorectal Malformation Timeline</a></p><h2>​Sources</h2> <p>American Pediatric Surgical Nurses Association. <a target="_blank" href="http://www.apsna.org/?page=TeachingMaterials">Posterior Sagital Anorectoplasty - PSARP (Pena procedure) Teaching Sheet</a></p>

 

 

Anorectal malformation959.000000000000Anorectal malformationAnorectal malformationAEnglishGastrointestinalNewborn (0-28 days);Baby (1-12 months)RectumRectum;AnusProceduresCaregivers Adult (19+)NA2013-11-08T05:00:00ZKimberly Colapinto RN (EC), MN, CETN(C);Sharifa Himidan MD10.000000000000059.00000000000001436.00000000000Health (A-Z) - ProcedureHealth A-Z<p>Learn what treatment is available if your child is diagnosed with anorectal malformation.</p><h2>What is an anorectal malformation?</h2><p>An anorectal malformation is a birth defect that causes the anus not to develop properly. It occurs in one in every 4,000 babies.<br></p> <figure class="asset-c-80"> <span class="asset-image-title">Anorectal malformation in boys</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_anorectal_malformation_male_EN.png" alt="Cross-section of normal pelvis in a boy and cross-section of pelvis with rectum connected to urethra and no anal opening" /> <figcaption class="asset-image-caption">In boys, anorectal malformation can happen when the rectum does not separate properly from the urinary system.</figcaption> </figure> <p>Some children are born with an anal opening that is too small, some have an anal opening that is in the wrong place and some have no anal opening at all. This can happen if the end of the intestine does not separate properly from your child's urinary system (in boys) or their vagina (in girls) while they are still in the womb.<br></p><p>A child who is born with an anorectal malformation might also have problems in other areas of their body. Your doctor will do tests to check for these problems soon after your child is diagnosed.</p> <figure class="asset-c-80"> <span class="asset-image-title">Anorectal malformation in girls</span> <img src="https://assets.aboutkidshealth.ca/akhassets/IMD_anorectal_malformation_female_EN.png" alt="Cross-section of normal pelvis in a girl and cross-section of pelvis with anus abnormally close to vagina" /> <figcaption class="asset-image-caption">In girls, anorectal malformation can happen when the rectum does not separate properly from the vagina. This causes the anus to be much closer to the vagina then it normally should be.</figcaption> </figure><h2>Key points</h2> <ul> <li>Anorectal malformation is a birth defect that causes a child to have an anal opening that is too small, an anal opening in the wrong place or no anal opening at all.</li> <li>Depending on your child's condition, the surgeon might dilate (stretch) their anus if it is too small or perform surgery to move the anus to the right place or create a new anus.</li> <li>After surgery, call your surgeon's office if your child has a <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=30&language=English">fever</a>, is <a href="https://akhpub.aboutkidshealth.ca/Article?contentid=746&language=English">vomiting</a>, has redness or swelling around their incisions or has more frequent or less frequent bowel movements than they normally have.</li> <li>Your child may have lifelong problems with bowel control or constipation. Your surgeon will only know this by following your child closely until they finish toilet training and later into their childhood and adolescence.</li> </ul><h2>Taking care of your child at home</h2><ul><li>Give your child a bath every day.</li><li>After the anoplasty or anorectoplasty you will see stitches around your child's new anus. Place an antibiotic cream on top of the stitches (do not rub it in) three times a day until you see the doctor in follow up.</li><li>Do not put anything into your child's bottom (for example a temperature probe) until your doctor tells you it is okay to do so.</li><li>Bring your child for follow-up appointments and follow any special care instructions.</li><li>To prevent <a href="/article?contentid=26&language=English">diaper rash</a>, apply ointments or creams to your child's bottom when they first start stooling from their anus.</li></ul><h2>When to call the surgery team</h2> <p>Call your surgeon's office if:</p> <ul> <li>your child has a <a href="/Article?contentid=30&language=English">fever</a> of 38°C (100°F) or higher</li> <li>your child is in pain<br></li> <li>your child is <a href="/Article?contentid=746&language=English">vomiting</a> (throwing up)</li> <li>your child has more frequent or less frequent bowel movements than they normally have</li> <li>your child has a swollen belly or serious diaper rash</li> <li>there is redness or swelling around the incisions</li> <li>there is no stool from the stoma</li> <li>the stoma is retracted (pulled back inside the skin) or prolapsed (coming out too far from the skin)</li> <li>the stoma is bleeding.</li> </ul> <p>You can also call if you have any other concerns about your child.</p><h2>Long-term effects of anorectal malformation</h2><p>Some of the muscles and nerves around your child's anus may not have formed properly. This means that your child may have lifelong problems with bowel control or <a href="/Article?contentid=6&language=english">constipation</a>. For example, your child's toilet training for stool may take longer than it does for another child or they may not be able to toilet train at all.<br></p><p>It is difficult to know for sure what problems, if any, your child will have until they reach the age of toilet training. Because of this, your child will need to be followed closely by their surgeon until toilet training is finished, and on into later childhood and adolescence.</p><p>Your surgeon and the surgical team will work closely with you and your child to make a bowel management plan so that your child will be able to wear underwear to school when the time comes. The plan might include having a <a href="/Article?contentid=1204&language=English">special diet</a>, using special medications or having enemas.</p><h2>How anorectal malformation is repaired</h2> <p>Your child may need surgery (an operation) to repair the malformation.</p> <h3>If the opening is too small</h3> <p>If the anal opening is in the right place but is simply too small, the doctor may only need to use a special dilator to slowly stretch it to make it the right size.</p> <h3>If the opening is in the wrong place</h3> <p>If the opening is in the wrong place, the surgeon may perform a surgery called anoplasty (see below) to put the anus in the right place.</p> <h3>If there is no opening or if the opening is far away from where it should be</h3> <p>If your child's anal opening is very far from where it should be, or if there is no opening at all, the doctor will need to create an ostomy for your child within 24 to 48 hours of birth.</p> <p>When your child is a little older, they will normally have a posterior sagittal anorectoplasty (PSARP), or Peña procedure, to create the anus in the right place. This is explained below.</p><h2>During the surgery</h2> <p>If your child needs an ostomy, anoplasty or anorectoplasty, they will have a special "sleep medicine" called a general anaesthetic. This means that your child goes to sleep and does not feel any pain during the operation.</p> <h3>Ostomy</h3> <p>An ostomy is an opening created from the inside of the body to the outside, on the tummy (abdomen). Stool passes through it and is collected in a pouch that is attached to your child's abdomen. In most cases, this ostomy is only temporary.</p> <p>Once your child has an ostomy, they will be like any other baby except that they will stool into the pouch. Before you leave the hospital, your health-care team will teach you how to care for your child's ostomy and when to call the doctor.</p> <h3>Anoplasty</h3> <p>This usually involves gently stretching your child's anal opening over several months and then performing surgery to move the anus when your child is older, before they start solid food.</p> <h3>Posterior sagittal anorectoplasty</h3> <p>A posterior sagittal anorectoplasty usually involves disconnecting the end of the intestine from the urinary system (for boys) or from the vagina or beside the vagina (for girls). An opening is then created to allow stool to come out of the intestine at the right place.</p> <p>If the connection was very high, the surgeon will sometimes do some of the surgery through your child's abdomen. This is usually done with a <a href="/Article?contentid=1005&language=English">laparoscope</a> (a small camera inserted through your child's belly button) and requires only tiny incisions (surgical cuts).</p><h2>After the surgery</h2><p>Your child can go home when:</p><ul><li>their heart rate, breathing, blood pressure and temperature are normal</li><li>they can eat without <a href="/Article?contentid=746&language=English">vomiting</a> (throwing up)</li><li>they are comfortable taking oral <a>pain medicine</a> (medicine taken by mouth)</li><li>the stoma is working well</li><li>your child's doctors and nurses have finished teaching you how to care for your child after surgery.</li></ul><h3>Follow-ups with the surgeon</h3><p>Your child will have their first follow-up with the surgeon two to three weeks after the anoplasty or anorectoplasty. It is very important that you attend this follow-up appointment when it is scheduled.</p><p>The surgeon will check your child and make sure that the stitches at the anus are healing properly. They will do this either by inserting their finger or using an instrument called a Hegar dilator. You may need to buy the Hegar dilator (it is not expensive).</p><h3>Dilations after surgery<br></h3><p>The surgeon may bring your child back for rectal calibration (gentle stretching of the new anus) with a finger or Hegar dilator or will teach you how to do it at home. Your child may need these dilations for several months after surgery. It is very important for your child's care that you meet with your surgeon and follow their instructions. If the anus does not heal properly, your child may need more surgery.</p><h3>When your child can start stooling normally</h3><p>When your surgeon is sure that your child has fully healed from the anoplasty or anorectoplasty, they will perform another operation to close your child's ostomy.</p><p>Your child will then start stooling from their anus and have many stools a day. As your child's bottom has never had stool on it before, they will be prone to <a href="/Article?contentid=26&language=English">diaper rash</a>. The nurse will teach you how to apply special ointments or creams to your child's bottom before you bring your baby home from hospital.</p><h2>Further information:</h2> <p><a href="http://www.sickkids.ca/pdfs/Good2Go%20Transition%20Program/38906-Anorectal%20Timeline-Handout.pdf" target="_blank">SickKids Good 2 Go Anorectal Malformation Timeline</a></p><h2>​Sources</h2> <p>American Pediatric Surgical Nurses Association. <a target="_blank" href="http://www.apsna.org/?page=TeachingMaterials">Posterior Sagital Anorectoplasty - PSARP (Pena procedure) Teaching Sheet</a></p>Anorectal malformationFalse

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