Anal Atresia

WHAT IS ANAL ATRESIA? (Closed anus in the baby)
Anal atresia is the failure of the anus opening to develop during the development of the baby in the womb or the inability to pass through the muscle complex (sphincter) where it should be due to its location. Since there is no opening in the anus, the baby cannot poop. This rare anomaly is very difficult to detect during prenatal ultrasound examinations. It occurs in approximately 1 in 5000 births. Diagnosis is made by seeing the baby's anus closed after birth. In addition, the baby's inability to poop and his/her belly is swollen also raise suspicion. It is easily noticed during the general examination during the postpartum period, and those with location anomalies are brought to hospitals by mothers complaining of chronic defecation difficulty in the future.
IS SURGERY REQUIRED, HOW IS THE SURGERY PERFORMED?

The procedure to be performed varies depending on whether there is an anal opening or the distance of the underdeveloped intestine from the place where the anus should be as a result of the examinations. If the anal opening is located in the front rather than within the muscle complex where it should be, the surgery is usually performed in a single session only from the anus area. If the anus opening has not developed at all, then colostomy is performed, and when the child reaches the appropriate age and weight, complementary surgery must be performed.
If these surgeries are not performed, the death of the baby is inevitable in the absence of an anus, and chronic constipation is inevitable in cases of placement anomalies.

The surgery varies depending on the procedure to be performed. In cases of placement anomaly, the surgery is performed from the anus area, while in cases where there is no anus, a part of the large intestine is mouthed to the upper part of the left groin area and the baby passes the stool into the bag placed there. The duration of the surgery varies depending on the procedure to be performed, but varies between 1 and 2 hours.
After the procedure; After the operation, the patient is monitored in the neonatal intensive care service or pediatric surgery service, depending on his age. The patient is hospitalized for 2-3 days depending on the condition of the surgery. While patients who underwent colostomy are fed as soon as bowel movements begin, patients who underwent single-session surgery in the anal area are not fed orally for 4 to 5 days, and the necessary nutritional support is given intravenously.
WHAT ARE THE POSSIBLE COMPLICATIONS OF THE SURGERY?

Wound infection; In patients who undergo single-session surgery, infection may develop in the anal area due to the opening of the stitches at the surgery site or the stitches coming loose due to force.
Anal stenosis; In the postoperative period, stenosis may develop at the surgery site, which can be corrected by dilatations.
Skin problems; These are skin problems characterized by redness around the skin, dampness, peeling of the skin surface, rash and discoloration.
Stoma ischemia and necrosis; It develops due to obstruction of blood circulation in the intestinal area where the stoma is opened. Stomaischemia is usually seen in the early postoperative period.
Stomaretraction; The stoma moves backwards towards the abdomen. It is one of the most important complications of colostomy, especially in the early stages. The probability of occurrence is between 1-8%.
Bleeding; Some bleeding is normal during cleaning of the stoma, but excessive bleeding is a condition that must be controlled.

Stomaprolapse; Prolapse is the excessive prolapse of the intestine through the stoma. It usually occurs months after surgery and the probability of occurrence is between 5-14%.
Parastomalhernia; Parastomal hernias are hernias that occur around the stoma. Parastomal hernia is an important late complication. Its incidence is stated as 1-20%. Parastomal hernia is important because it carries the risk of intestinal obstruction and strangulation.
Atelectasis and pneumonia; As in every postoperative period, lung infection may develop, which may be cured with treatment but may also result in death.

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