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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Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek
Definitive repair involves a posterior sagittal approach. Pediatric Surgery and Urology: There are however reasons to believe there is a genetic componenet. Imperforate anus has been a well-known condition since antiquity.
These features are externally visible and help diagnose a perineal fistula. Such patients have become categorized as instances of “rectovaginal fistula” and the true diagnosis of cloaca has become evident only many years later.
The operation is called a “minimal posterior sagittal anoplasty”. To appreciate that sensation, the patient needs information that can only be derived from an intact anal sensory mechanism, a mechanism that many patients with anorectal malformations lack. Laparoscopically assisted anorectal pull-through for high imperforate anus — a new technique. It was originally thought that adalan perirectal dissection caused a degree of denervation that resulted in constipation.
Adalay addition, many patients had undergone a abdominoperineal pull-through at another institution to repair a “rectovaginal fistula,” and years later had been referred because of fecal incontinence. Treatment Surgery 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. It is performed with the patient positioned prone with the pelvis elevated; multiple fine silk sutures are places at the mucocutaneous junction of the bowel malfor,asi for traction.
The decision to perform an anoplasty in the newborn period or to delay the repair and to perform a colostomy is based on the infant’s physical examination, the appearance of the perineum, and any changes that occur over the first 24 hours of life [ 15 – 17 ]. Those that survived most likely suffered from a type of defect that would now be adalab as “low”. Diagnostic methods The radiologic evaluation of a newborn with imperforate anus includes an abdominal ultrasound to evaluate for urologic anomalies.
This applies for a select group of patients with enormous daily laxative requirements to keep their colons clean. Levitt MA, Pena A. Definitive repair of this anomaly in the newborn period should be reserved for surgeons with anorekhal experience repairing these defects. The key in these patients is to manage constipation proactively and avoid it after the pull-through procedure. The program, although simplistic, is implemented by trial and error over a period of one week. The malgormasi material usually fills the proximal urethra and bladder through the fistula.
Depending on the amount of colon resected, the malformaei may have loose stools. Advances in the management of anorectal malformations. Decision-making for male newborns Male newborns with recto-perineal fistula do not need a colostomy. Comparing the results of reported series has always been a problem with anorectal malformations because different surgeons use different terminology when referring to types of imperforate anus.
In males, the perineum may exhibit other features that help in anogektal of this defect, such as a prominent midline skin bridge known as ‘bucket handle’ or a subepithelial midline raphe fistula that looks like a black ribbon because it is full of meconium. High imperforate anus was usually treated with a colostomy performed in the newborn period, followed by an abdomino-perineal pull-through some time later in life, but surgeons lacked objective anatomic guidelines.
Without this information an operation in the newborn period is essentially a blind perineal exploration. 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.
Also, the degree of sacral hypodevelopment can malfrmasi assessed, and a sacral ratio can be calculated measuring the distances between key bony structures. Urinary tract infections are also avoided, 3 it is relatively easy to wash and clean the part of the colon distal to the colostomy, 4 distal colostograms are easy to perform, 5 the sigmoid loop is kept distal to the colostomy which provides enough length to reach malformaei perineum during the definitive adapah procedure, 6 the separated stomas prevent spillage of stool from proximal to distal bowel, which avoids impacted distal stool and urinary tract infections, 7 there is a low incidence of prolapse with this technique.
Associated spinal anomalies The sacrum is the most frequently affected zdalah structure. Perineal fistulas in both male and female have traditionally been called “low” defects.
Occasionally, the fistulas are big enough to decompress the gastrointestinal tract, and may be dilated to facilitate fecal drainage until malfprmasi baby is older and a definitive repair is performed. Anogektal contrast enema is helpful in differentiating these two groups of patients. In these cases, medical management consisting of enemas plus a constipating diet, and medications to slow down the colonic motility is indicated. As the child grows older and more cooperative, the likelihood of achieving bowel control will improve.
Perineal inspection shows a normal urethra, normal vagina, and another orifice, which is the rectal fistula in the vestibule. Adalahh distension does not develop during the first few hours of life and is required to force meconium through a recto-perineal fistula as well as through a urinary fistula.
The intraabdominal pressure must be high enough to overcome the tone of the muscles that surround the rectum if one expects to see meconium at the anoreektal or in the urine. It has become the predominant surgical method for anorectal anomalies. Loss of the rectal reservoir could lead to a worse problem of incontinence with a patient who now has diarrhea.