Nixon Anoplasty

We recommend the "Nixon anoplasty" as the most satisfactory repair [73,74]. The lateral flap proctoplasty [73] was originally added to the "Kiesewetter-Rehbein" pull-through. It can be added to any form of pull-through and can also be used as a secondary procedure to correct postoperative prolapse.

This simplest form of anoplasty was fist described by Nixon in 1967 [73], but is not widely known. We and others use it regularly in both primary and secondary rectoplasties or in a few cases for revision anoplasty after stricture or mucosal ectopy. It creates a skin-lined anus, which reduces mucus discharge, preserves anal sensation, and is cosmetically satisfactory. A series is also reported by Davies and Cywes [74]. Nixon originally advocated incision of triangular areas of skin, but later suggests "kite"-shaped areas. The resulting anus is not so "tubular" and easier to clean.

Kite-shaped excisions of skin are taken from the perineum in front of and behind the anal site so that lateral advancement flaps are formed. (Fig. 31.21) The incision at the anal site must be long enough to form the circumference of an adequate anus (proximately 1.5-2 cm). The sutures include sphincter muscle as well as skin and bowel wall and are tied loosely to avoid cutting out. When the surgery is carried out secondarily for prolapse it may be necessary to excise a considerable amount of redundant "rectum," but control of prolapse depends mainly on the sutures attaching the bowel to the sphincter muscle. This has not proved to be necessary in the usual case treated by the minimal mobilization inversion anoplasty, but has been used on rare occasions in a slightly modified form to allow for the presence of the "Mollard flap," the large anterior and smaller posterior excision

Advancement Flap Anoplasty

Fig. 31.21 A-C Nixon anoplasty (from Stephens and Smith [2] with permission of the publishers). A Incisions in the perineum, as shown by the lines. The kite-shaped areas of skin are excised. Each edge of the incision is sutured to 180° of the circumference of the bowel. By closing the "kites" of the skin flaps, the anastomosis ascends cephalically and creates a skin-lined anus. B The operative appearance before the closure of the "kites". C Postoperative appearance

Fig. 31.21 A-C Nixon anoplasty (from Stephens and Smith [2] with permission of the publishers). A Incisions in the perineum, as shown by the lines. The kite-shaped areas of skin are excised. Each edge of the incision is sutured to 180° of the circumference of the bowel. By closing the "kites" of the skin flaps, the anastomosis ascends cephalically and creates a skin-lined anus. B The operative appearance before the closure of the "kites". C Postoperative appearance forming posterolateral flaps, which retain an adequate base for their blood supply.

Mirsi et al. also described a sliding skin graft technique, and Freeman has utilized the penile foreskin to create a skin-lined anal canal. Millard and Rowe [75] described a double skin flap procedure, one flap being a dorsally based trap-door incision at the anal site, and the defect being covered by a second flap from the scrotum and thigh.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

Get My Free Ebook


Post a comment