Transperineal ten-shaped incision anoplasty

The perineal ten-shaped incision anusplasty is a congenital anorectal malformation surgery. The choice of the method depends on the type of malformation. The choice of operation time is determined by the combination of fistula or not. Treatment of diseases: anal fissure, perianal abscess Indication Perineal surgery (1) Anal membranous atresia is suitable for ten-shaped incision anusplasty. (2) Anal stenosis is suitable for Z-shaped anal angioplasty. (3) Perineal anal angioplasty adapts to the low position of the rectal blind end below the PC line, such as anal skin spasm, anal vestibular fistula and so on. 2. Colostomy (1) All kinds of medium and high deformities are generally poor and cannot tolerate other operators. (2) Those with moderate or high deformity without fistula should first undergo colostomy, and then undergo radical surgery six months later. 3. Abdominal perineal anusplasty (1) high or combined rectal urethral fistula, rectal vaginal fistula. (2) Middle or low malformation or combined with rectal urethral fistula, rectal vaginal fistula, rectal vestibular fistula and so on. 4. perineal anusplasty: (1) High, medium or combined sputum. (2) Low-level combined sputum. Contraindications Aged and debilitated, the important organs of the heart, lungs and other functions are poor. Preoperative preparation 1. Take the inverted pelvic lateral slice, determine the type of rectal anal deformity from the position of the full rectal blind end, and determine the operation time and operation mode. It is determined according to the relative position of the rectal blind end to the PC line and the I line. (1) The newborn needs to be 12 to 24 hours after birth, and the gas to be swallowed reaches the rectal poster. (2) Stand upside down for 1 to 2 minutes, press the abdomen to let the air enter the blind end. (3) Anal point labeling. (4) Taking X-ray films centered on the pubic symphysis. 2. Place the catheter before surgery as a sign to protect the urethra when separating the rectum. 3. Correct water and electrolyte imbalance before surgery. Prepare blood 200 to 400ml. Fasting 12 hours before surgery. 4. Place the stomach tube. 5. On the 1st day before surgery, ampicillin, 50mg ~ 100mg / kg, intravenous drip. 6. Clean the enema before surgery (through the fistula). 7. Inject 1% neomycin solution 3ml/kg from the fistula 12 hours before surgery. 8. 1 hour before surgery, intramuscular injection of luminal 2mg ~ 4mg / kg, subcutaneous injection of atropine 0.01mg ~ 0.02mg / kg. Surgical procedure 1. Position, incision: lithotomy position. A ten-shaped incision is made in the center of the anal point and on the surface of the external sphincter. 2. Cut the rectal blind bag: Open the flap, find the rectal blind bag, and make a ten-shaped incision at the end of the blind bag corresponding to the skin's ten-shaped tangent or 45°. Prepare the suction device to absorb the meconium. 3. Stitching: Rinse clean, and the 4 petals after the incision of the intestine wall are interlaced and sutured with the 4 petals of the skin. complication 1. Anal stenosis. 2. Anal incontinence. 3. Rectal mucosal eversion. 4. Infection around the rectum.

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