Novosti
Khirurgii
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Year 2008 Vol. 16 No 4

PEDIATRIC SURGERY

LEVIN M.D., TROYAN V.V.

PATHOLOGIC PHYSIOLOGY, DIAGNOSTICS AND PERSPECTIVE TREATMENT OF LOW IMPERFORATE ANUS WITH FISTULAS

In spite of the fact, that imperforate anus with perineal or vestibular fistula is considered to be a low anorectal anomaly, the majority of surgeons use posterior sagittal anorectoplasty (Pena and de Vries) for its correction, i.e. the same procedure that is used to correct high anomalies. 10% to 30% of the postoperative patients suffer from total fecal incontinence and more then 70% from chronic constipation.
It was shown that patients with these anomalies have normally formed anal canal. However, the opening of the fistula, which is usually narrower than fecal mass, is formed in the rectum with forward displacement from the proper location of the anal orifice. Megacolon and chronic constipation develop as a result of this relative stenosis in patients who are 3 + months old. The process of persistent straining of the puborectal muscle gradually results in the shortening of the anal canal. The caudal part of the anal canal does not fully open to the normal width due to muscle rigidity of the perineum. The operative procedure must be carried out before this pathologic alteration occurs.
The operating procedure of the anal orifice formation consists of brining the distal caudal wall of the anal canal to the tunnel inside the external anal sphincter using a curved catheter inserted into the fistula. This wall is separated from the surrounding tissue on the depth of 1 cm and split. Then, its edges are sewn to the skin of the perineum. After the daily widening of the anal canal, closing of the fistula isdone under the colostomy protection. Unlike the Pena operation, this procedure spares pelvic muscles from injury. And if it is done prior to megacolon development, it has good functional prognosis.

Keywords: newborn, imperforate anus, rectal atresia, anorectal fistula, vestibular fistula, pathologic physiology, anorectal anomalies, surgical treatment.
p. 65 76 of the original issue
References
  1. Pena,A. Potential anatomic sphincters of anorectal malformations in females / A.Pena // Birth. Defects Orig. Artic. Ser. 1988. Vol. 24, N 4. P. 163-75.
  2. Stephens,F.D. Potential anatomic sphincters of anorectal malformations in males / F.D.Stephens // Birth. Defects Orig. Artic. Ser. 1988. Vol. 24, N 4. P. 155-61.
  3. By the Japan sudy group of anorectal anomalies. A group study for the classification of anorectal anomalies in Japan with comments to the International classification (1970) // Pediatr. Surg. 1982. Vol. 17. P. 302-308.
  4. Gans,S.L. Congenital anorectal anomalies: changing concepts in management / S.L.Gans, N.B.Fridman, J.S.David // Clin. Pediatr. 1963. Vol. 2, N 11. P. 605-613.
  5. Caffey,J. Pediatric x-Ray diagnosis / J.Caffey. Chicago ets.: Springer, 1978. 1737 p.
  6. ,. . / .., .. // . 1984. 12. C. 78-82.
  7. / .. [ .] // . 1983. 4. C. 92-97.
  8. Frenckner,B. Ano-rectal manometry in the diagnosis of Hirschprungs disease in infants / B.Frenckner // Acta Pediatr. Scand. 1978. Vol. 67, N 2. P. 187-92.
  9. Meunier,P. Lexploration manometrique de lappariel ano-rectal de lenfant / P.Meunier, P.Mollard, J.de Beanjew // Pediatrie (Lyon). 1974. Vol. 29, N 7. P. 679-88.
  10. ,.. / .. // . . 1985. 2. C. 40-45.
  11. Nussel,D. Semiologie radiologique fonctionelle dans la maladie de Hirschprung et dans dautres formes de dischesie / D.Nussel, N.Genton, C.Bozic // Ann. Radiol. 1976. Vol. 19, N 1. P. 111-122.
  12. Simultaneous endoluminal sonography and manometry to assess anal sphincter complex in normal subjects / R.F.Wong [et al.] // Dig. Dis. Sci. 1998. Vol. 43, N 11. P. 2363-2372.
  13. ,.. / .., .. // . 1983. 8. C. 20-24.
  14. ,.. / .. // . 1983. 2. C. 49-52.
  15. Videodefecography: a study of the motile pattern / A.Shafik [et al.] // Surg. Radiol. Anat. 2003. Vol. 25, N 2. P. 139-144.
  16. ,.. // / ... 1989. 5. C. 10-16.
  17. ,.. // / .. , .., ..-. 1990. 8. . 78-82.
  18. Cinedefecographic findings in patients with obstructed defecation sindrome A study in 420 cases / A.Renzi [et al.] // Minerva Chir. 2006. Vol. 61, N 6. P. 493-499.
  19. hatterjee,S.K. Double termination of the alimentary tract: second look / S.K.hatterjee // Pediatr. Surg. 1980. Vol. 17, N 5. P. 623-627.
  20. de Vries,P.A. The staged sequential development of the anus and rectum in human embryos and fetuses / P.A.de Vries, G.W.Friedland // J. Pediatr. Surg. 1974. Vol. 9, N 5. P. 755-769.
  21. Normal and abnormal embryonic development of the anorectum in human embryos / R.A.Nievelstein [et al.] // Teratology. 1998. Vol. 57, N 2. P. 70-78.
  22. Lin,J.N. Anorectal malformations update 1998 / J.N.Lin // Changgeng Yi Xue Za Zhi. 1998. Vol. 21, N 3. P. 237-250.
  23. de Vries,P.A. Posterior sagittal anorectoplasty / P.A.de Vries, A.Pena // J. Pediatr. Surg. 1982. Vol. 17, N 5. P. 638-643.
  24. Treatment of vestibular fistulas in older girls / R.Sanchez Martin [et al.] // Cir. Pediatr. 2002. Vol. 15, N 4. P. 140-144.
  25. Anorectal function and endopelvic dissection in patients with repaired imperforate anus / C.C.Chen [et al.] // Pediatr. Surg. Int. 1998. Vol. 13, N 2. P. 133-137.
  26. J. Pediatr. Surg. / R.Rintala [et al.]. 1993. Vol. 28, N 8. P. 1054-1058.
  27. Posterior sagittal anorectoplasty: functional results of primary and secondary operation in comparison to the pull-through method in anorectal malformations / W.Mulder [et al.] // Eur. J. Pediatr. Surg. 1995. Vol. 5, N 3. P. 170-173.
  28. Prospective controlled long-term follow-up for functional outcome after anoplasty in boys with perineal fistula / M.P.Pakarinen [et al.] // J. Pediatr. Gastroenterol. Nutr. 2007. Vol. 44, N 4. P. 436-439.
  29. Haider,N. Mortality and morbidity associated with late diagnosis of anorectal malformations in children / N.Haider, R.Fisher // Surgeon. 2007. Vol. 5, N 6. P. 327-330.
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