Please note a valid referral from your GP or specialist is required.

There are two common causes of gallstone disease in children and these occur in roughly equal proportions. The first cause is in children who have increased breakdown of their red cells such as in sickle cell disease, thalassemia, or spherocytosis. These diseases often run in families and so people already know about them. Because the red blood cells are being broken down at a higher rate the bilirubin that is one of the building blocks of the red blood cell can accumulate in the gallbladder causing bilirubinate stones. These stones can occur at any age even in very young children.

The second common cause of gallstones in children are cholesterol stones. There is often a family history of gallstones and it affects teenage girls more often than boys. Gallstones can present in a number of ways but usually present with abdominal pain. This pain can be central or right sided and some children describe the pain as going around to their back. It can be bought on by meals, especially meals with a high fat content. A number of children with gallstone disease already have very little fat in their diet. They avoid fat because they know that this can bring on the symptoms. More serious problems caused by gallstones is when they escape from the gallbladder into the common bile duct. Here they can cause an obstruction and the child may become jaundiced or they could cause an episode of pancreatitis.

• Ano means the anus. This is the opening at the end of the large intestine. Stool passes through here when there is a bowel movement.
• Rectal means the rectum. This is the part of the large intestine just above the anus.

Normally during a bowel movement, stool passes from the large intestine to the rectum and then to the anus. Muscles in the anal area help to control when you have a bowel movement. Nerves in the area help the muscles sense the need for a bowel movement. The nerves also stimulate muscle activity.

With an anorectal malformation, several problems can occur. These include:

• The anal passage may be narrow
• The anal opening may be covered with a tissue or membrane
• The rectum may not connect to the anus
• The rectum may connect to part of the urinary tract or the reproductive system. This happens through a passage called a fistula.

Anorectal malformations cause problems with how a child has a bowel movement. Treatment depends on which type of problem your baby has.

Anorectal malformation may be seen with some genetic syndromes or congenital problems that are present at birth. These include:

• VACTERL association. This disorder includes problems with the spine, anus, heart, trachea, esophagus, kidneys, and arms and legs.
• Digestive system problems
• Urinary tract problems
• Spinal problems
• Down syndrome

While low-type imperforate anus in most cases, low-typed malformation could be corrected by one-staged anoplasty but a temporary defunctioning colostomy usually required in intermediate or high-type malformation before the definitive repair. The difinative surgery can be performed with key hole surgery ( laparoscopic assisted rectal pull through (LARP)) Apart from being minimally invasive, LARP also possesses an advantage in the management of high-type malformation such recto-vesical fistula that would require laparotomy. The magnification property of laparoscopy also allows the accurate placement of the pull-through rectum.

These operations may be performed by thorcoscopy through tiny incisions, depending upon the type of procedure and the size of the patient.