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Anal shift: preliminary results
Ashok J Shah1, N Bhattacharjee, D N Patel
1Department of Pediatric Surgery, Sheth K.M. School of P.G. Medicine & Research and V.S. General Hospital, Ahmedabad, India.
Insights
A new surgical technique called Anal Shift offers a simple and effective solution for correcting anterior ectopic anus in female infants. This procedure avoids colostomy and results in normal anal function and an aesthetically acceptable outcome.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Surgical Innovation
Background:
- Perineal ectopic anus is a common congenital anomaly in female infants.
- The condition often presents with a stenosed opening close to the vulva, requiring surgical intervention.
- Existing surgical methods include posterior anal transposition and PSARP, sometimes with colostomy.
Purpose of the Study:
- To introduce and describe a novel, simpler surgical procedure for correcting anterior ectopic anus in female infants.
- To evaluate the efficacy and aesthetic outcomes of the Anal Shift technique.
- To present a colostomy-free surgical approach for this condition.
Main Methods:
- The study reports on twelve female infants (3-18 months) treated with the Anal Shift technique.
- The procedure involves repositioning the anus to the normal anatomical site and constructing the perineal body.
- No diverting colostomy was performed in any of the cases.
Main Results:
- Follow-up ranged from 12 to 24 months, showing normal anal function and satisfactory vulvo-anal distance.
- No anal stenosis was observed post-surgery.
- One patient experienced superficial wound dehiscence but achieved good results after reoperation.
Conclusions:
- Anal Shift is a simple and safe surgical procedure for anterior ectopic anus in girls.
- The technique preserves rectal support and neurovascular supply, minimizing retraction risk.
- The absence of a suture line on the anterior neoanus reduces stricture formation, offering a satisfactory outcome without colostomy.
Background/Purpose:
Perineal ectopic anus in female infants is not a very uncommon congenital anomaly. The close proximity of the ectopic anus with the vulva and the stenosed opening seen in large majority of cases necessitate some form of surgical correction. A variety of surgical procedures like cutback, posterior anal transposition, PSARP, or ASAPR, with or without diverting colostomy have been described in the literature. However, in dealing with a case of ectopic anus, the authors thought a much simpler surgical correction would suffice giving an aesthetically and functionally acceptable perineum. This new and simple surgical procedure developed by Ashok Shah, Anal Shift is described in this report.
Methods:
Twelve female infants with anterior ectopic anus, between 3 and 18 months of age who had undergone surgical correction by this new method (Anal Shift) is reported. Five of these children had severe and 2 had mild anal stenosis. The new technique described in detail includes shifting and creation of a new anus in the anatomically normal site and construction of the perineal body. Colostomy was not done in any of them.
Results:
The cases had been followed up for 12 to 24 months. Anal function was normal with satisfactory vulvo-anal distance without any stenosis. One patient had superficial anterior wound dehiscence; she underwent reoperation with good results.
Conclusions:
Anal Shift is a simple surgical procedure. It does not necessitate lateral dissection, therefore, the rectal support and the neurovascular supply to the rectum remains undisturbed, eliminating any chance of retraction. The anterior half of the neoanus does not have a suture line, thereby minimizing the chances of stricture formation. Anal Shift appears to be a safe, simple and satisfactory surgical procedure to correct anterior ectopic anus in girls without a colostomy.
