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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Fecal and urinary incontinence can occur even with an excellent anatomic repair, due mainly to associated problems such as a poorly developed sacrum, deficient nerve supply, and spinal cord anomalies.
The anorekttal concerns for the surgeon in correcting these anomalies are bowel control, urinary control, and sexual function.
Advances in the management of anorectal malformations. Patients like this are often referred with “fecal incontinence. Normally, they are used only for brief periods, when the rectal fecal mass reaches the anorectal area, pushed adalau the involuntary peristaltic contraction of the rectosigmoid motility.
When a patient with a megasigmoid has been shown to be fecally continent, resection of the sigmoid has been found to dramatically reduce the patient’s laxative requirements.
Detailed surgical procedure can be found in the following references: Cambridge University Press; Antegrade enema procedures, whereby enema is introduced in a conduit via appendicocecostomy, has been devised to help the patient clean its bowel [ 3031 ]. These complications may compromise the ultimate functional prognosis.
Spinal ultrasound in the znorektal 3 months of life and magnetic resonance imaging thereafter are useful radiologic modalities to establish the diagnosis. The artificial bowel sphincter and electrically stimulated gracilis neosphincter are two relatively new techniques that have been used for the treatment of patients with severe refractory fecal incontinence.
It was originally thought that the perirectal dissection caused a degree of denervation that resulted in constipation. Without this information an operation in the newborn period is essentially a blind perineal exploration. This assertion is supported by the authors’ experience of cloaca reoperations where it has been found that most patients who were originally operated on by a surgeon who classified the defect as a “rectovaginal fistula” had only the rectal component of the cloaca repaired and had been left with a persistent urogenital sinus.
If the spine was not evaluated in the newborn period with ultrasound, magnetic resonance imaging is necessary after age 3 months to rule out the presence of tethered cord and other spinal anomalies. Anterior sagittal approach, involving anterior perineal dissection from the base of the scrotum to the posterior part of the anodermis used by some surgeons, with the aim of mallformasi the internal anal sphincter [ 26 ].
The enormously dilated rectosigmoid, with normal ganglion cells, behaves like a myopathic type of hypomotile colon.
Table 1 Classification of non-syndromic anorectal malformations ARM. Presentations of pelvic pain or amenorrhea as teenagers should prompt the assumption of anomalous gynecologic structures. Anorectal Malformations anprektal Children.
There, accurate information is provided by the anal canal concerning the consistency and quality of the stool.
Failure to avoid constipation can result in megarectum and megasigmoid, and can lead to fecal impaction and overflow incontinence.
The preferred colostomy is a descending colostomy, i. Levitt MA, Pena A. Hemivertebrae may also affect the lumbar and thoracic spine, leading to scoliosis.
Malformasi Anorektal | Lokananta | Jurnal Kedokteran Meditek
Anorectal malformations ARM represent a spectrum of abnormalities ranging from mild anal anomalies to complex cloacal malformations. The etiology of such malformations remains unclear and is likely multifactorial. 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.
Posterior sagittal anorectoplasty is superior to sacroperineal-sacroabdominoperineal pull-through: Colostomy type in anorectal malformations: The operation is called a “minimal posterior sagittal anoplasty”.
In the case of persistent cloaca, a distended vagina hydrocolpos can be identified. Patients who have undergone abdominoperineal operations for imperforate anus that included resection of the rectum suffer from a tendency to have diarrhea due to a lack of a rectal reservoir.
The functional results of the repair of anorectal anomalies seem to have significantly improved since the advent of the posterior sagittal approach. The early management of a newborn infant born with an anorectal anomaly is crucial and two important questions must be answered during the first 24 to 48 hours of life.
This is the best way to demonstrate a recto-urinary communication, and to determine the real height of the rectum. The key in these patients is to manage constipation proactively and avoid it after the pull-through procedure.
This misconception has important therapeutic implications that will be discussed below.
The patients must be followed regularly, and laxatives and dietary manipulations are begun at the first sign of constipation. Unfortunately this left many patients incontinent and was not an appropriate solution to the spectrum of malformations.
A spinal ultrasound in the newborn period and up to age 3 months at which time the sacrum becomes ossified can look for evidence of a kalformasi spinal cord and other spinal anomalies. Complications of posterior sagittal anorectoplasty. Once the rectum is completely mobilized, a perineal body is constructed, and the rectum is placed within the limits of the sphincter mechanism [ 21 ].
Or, perhaps it is the hypomotility that causes dilatation, which in turn results in constipation, creating a vicious cycle. 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 the perineum during the definitive pull-through 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.
Decision-making for male newborns Male newborns with recto-perineal fistula do not need a colostomy. This x-ray on rare occasion may show the column of air in the distal rectum to be within 1 cm of the perineum, and if this is the case, the baby can be treated like those with a recto-perineal fistula, and a newborn perineal operation can be performed.
For patients with a common channel greater than three cm, a laparotomy is usually required.