Imperforate Anus or Anorectal Malformation: Surgical Repair

When it comes to performing surgery on children with complex anorectal malformations and colorectal conditions, experience is critical. Thousands of children needing specialized reconstructive repair –including families from many different countries around the world - have come to Nationwide Children’s Center for Colorectal and Pelvic Reconstruction (CCPR) because of the unparalleled expertise of its surgical team.

CCPR staff creates a personalized treatment plan for each child that addresses specific malformations, future growth considerations and any other health conditions. Special attention is given to post-surgery recovery to help ensure that children regain as much bowel function and control as possible.

Surgical Procedures

For a child with imperforate anus /anorectal malformation, Hirschsprung Disease, cloacal malformation or any other condition that prevents the body from safely eliminating stool, the immediate goal of surgery is to provide a way for the body to pass waste safely and reduce the risk of infection.

In some cases, a single reconstructive surgery can help restore a way for the body to pass waste; however, most complex malformations often times will require a series of surgeries, performed over several months or years, to help normalize bowel function.  Depending on the severity of the condition, surgeries can be done within the first few days or weeks of a baby’s life, or can be delayed for several months if necessary.

Here are a few of the surgical procedures that our team regularly performs for the treatment of Hirschsprung disease, imperforate anus/anorectal malformation, cloacal malformation and other colorectal conditions.

  • Colostomy: this procedure connects one end of the large intestine or the colon to a stoma (hole) created in the abdomen, and allows stool to exit the body into a collection bag. Click here to read more about colostomy surgery, closure and recovery.
  • Ileostomy: this procedure connects one end of the ileum (the lower part of the small intestine) to a stoma (hole) created in the abdomen, and allows stool to exit the body into a collection bag. Click here to read more about ileostomy surgery and recovery.
  • Anorectal reconstructionsthese types of repair surgeries create a normal connection between the rectum (the very end of the large intestine) and the anal opening, and closes off any fistulas (abnormal openings) that prevent healthy bowel movements. The type of reconstructive surgery your child has will depend on his/her specific malformation. Click here to read more about anorectal reconstructive surgeries.
  • Posterior sagittal anorectoplasty (PSARP)PSARP, also known as the “pull through procedure” is the technique used in a variety of anorectal reconstructive surgeries, including anorectal malformations to help improve outcomes and minimize damage to surrounding organs. Click here to read more about PSARP and recovery, and Nationwide Children’s unique experience in using this type of surgical technique.
  • Transanal pull through procedure: This technique is for Hirschsprung disease and is sometimes combined with laparoscopy. Click here to read more about pull through for Hirschsprung disease.
  • Appendicostomy:  Also known as a Malone Procedure (MACE), this is a procedure offered to children with fecal incontinence who are ready (and old enough) to take over the medical management of their bowels. The surgery connects the appendix to a valve in the belly button. The valve allows children to perform their own enemas without needing a parent’s help. Children must also be part of a bowel management program. Click here to learn more about appendicostomy.
  • Cecostomy: Similar procedure to an appendicostomy for giving enemas but uses a tube instead of the patient’s appendix.

Most of the procedures at the Center for Colorectal and Pelvic Reconstruction are done using laparoscopic or “minimally invasive” surgery. With this technique, surgeons don’t have to make large cuts in the body. Instead, the surgeon will make a few tiny cuts in the abdomen, and use specialized cameras and tools to conduct the surgery. Laparoscopy can help reduce pain, healing time and the risk of infection.  It is the preferred method of surgery for repairing anorectal malformations and Hirschsprung disease. 

Diagnostic Procedures

If an issue is found, the doctor will do a number of tests to better understand the problems and to develop a long-term plan for the best outcome.  For information on diagnostic procedures, click here

The Road to Recovery: After Surgery

Post-surgery recovery plans are designed to help your child heal and set the stage for successful, long term bowel control. These plans can cover several aspects of your child’s health including diet, anal dilations, wound care, and potty training. For information on avoiding post-surgery complications and improving potty training goals click here