Anorectal malformation (ARM) is a condition where the anus and rectum (the terminal part of the gastrointestinal tract) do not form properly. In a normal baby, stool moves from the colon to the rectum and out through the anus. In a child with ARM, this route is either obstructed or missing. In other instances, the rectum can be joined to other organs like the urinary tract or reproductive system, or the opening can be absent or misplaced.
This condition comes about in early pregnancy when the digestive system of the baby is developing. Nothing the mother ever did or failed to do when pregnant causes this condition. The genetic and environmental factors may play a part.
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There are a number of different types of anorectal malformations, and they are typically categorized as low-type, intermediate-type, and high-type malformations based on how high the obstruction is and where the rectum terminates.
The rectum in low-type ARM is near the skin and opens close to the usual location but not precisely at the right place. This is less difficult to fix and has better results.
In high or type ARM, the rectum terminates higher in the pelvis and can be joined to other structures such as the bladder (recto-urinary fistula) or vagina (recto-vaginal fistula in females). These are more complicated and might need more than one operation.
Other health problems can also occur in some babies, for example, spinal, kidney, heart, or limb issues. That is why an overall assessment is necessary if ARM is diagnosed.
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Symptoms of anorectal malformation are typically observed shortly after birth. Some of the common symptoms are:
If the doctors observe any of these signs, they will do tests like physical examination, X-rays, ultrasound, or MRI to verify the condition and arrange the next step.
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The precise etiology of anorectal malformation is not always certain. It is, however, supposed to result from impaired development of the lower part of the digestive system during fetal development. Under normal circumstances, the rectum and anus are isolated from the urinary and genital organs between the 4th and 8th weeks of gestation. If the separation fails to happen as it should, the child is delivered with ARM.
Some of the potential causes or risk factors are:
It should be noted that anorectal malformation is not the parents' fault and cannot typically be prevented.
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The primary treatment of anorectal malformation is surgical repair, and the procedure varies with the type and severity of the condition.
In minor cases, one stage of surgery may suffice in establishing a proper anal opening. More complex cases, however, may need a three-stage process:
In the first stage, if the baby cannot pass stool or has a high-type malformation, the doctor creates a temporary opening in the abdomen called a colostomy. Through this, waste can exit the body into a bag. This helps keep the baby healthy until the main repair can be done.
This is the primary repair surgery performed when the baby is 2–3 months of age or according to the physician's recommendation. The surgeon establishes a new opening of the anus in the right location and sews the rectum to this opening. This enables the baby to have bowel movements normally.
The operation could be open or laparoscopic, depending on the situation. Laparoscopic surgery uses smaller incisions, quicker recovery, and less pain.
If a colostomy was previously performed, this last step is closing the temporary opening after the new anal passage is functioning properly.
In low-type ARM, most infants will not require a colostomy and can have single-stage surgery early in life.
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Because anorectal malformation surgery is done on sensitive parts of the body, it ought always to be conducted by a pediatric surgeon with expertise in this condition. Pediatric surgeons are trained to deal with children and possess the appropriate skills and equipment for conducting surgeries on tiny bodies.
Other than surgery, the child will require follow-ups and bowel training support. Some children will have difficulties with potty training or stool control and may require assistance from a pediatric gastroenterologist, dietitian, or physiotherapist.
Recovery varies depending on the surgery. In most instances:
The cost of anorectal malformation surgery in India varies based on a number of factors such as:
| Procedure | Surgical Technique | Estimated Cost Range (INR) |
|
Piles (Hemorrhoid) Surgery |
Open Surgery | ₹20,000 – ₹55,000 |
| Laser Surgery | ₹30,000 – ₹55,000 | |
| Stapled Hemorrhoidectomy | ₹20,000 – ₹80,000 | |
| Rubber Band Ligation | ₹22,000 – ₹65,000 | |
| Sclerotherapy | ₹25,000 – ₹70,000 | |
|
Anal Fissure Surgery |
Open Surgery | ₹15,000 – ₹90,000 |
| Laser Surgery | ₹32,000 – ₹60,000 | |
| Lateral Internal Sphincterotomy | ₹30,000 – ₹70,000 | |
|
Anal Fistula Surgery |
Open Surgery | ₹15,000 – ₹1,20,000 |
| Laser Surgery | ₹35,000 – ₹60,000 | |
| Advancement Flap Procedure | ₹70,000 – ₹80,000 | |
| Anorectal Malformation Repair | Surgical Repair (Children) | Varies based on complexity |
Kids who have successful anorectal malformation surgery can have a normal, healthy life. Still, some will have issues such as:
By way of follow-up regularities, ideal diets, toileting regimens, and periodic drugs or enemas, a great many of these troubles may be best dealt with effectively. Long-term bowel control greatly involves early treatment.
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