Anal shift: Preliminary results

Abstract

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. J Pediatr Surg 38:196-198. Copyright 2003, Elsevier Science (USA). All rights reserved.