Year 2010 Vol. 18 No 6

LECTURES, REVIEWS

LEVIN M.D., TROYAN V.V.

PATHOLOGICAL PHYSIOLOGY, DIAGNOSTICS AND PROSPECTS FOR TREATMENT OF THE LOW IMPERFORATE ANUS IN NEWBORNS

Despite enormous interest in the development of an ideal operation procedure to treat congenital anorectal malformations, the situation is as confusing today as it was 30 years ago. The soling or chronic constipation is observed in one third of all postoperative patients, most frequently after the correction of the high or intermediate anomalies. It was shown that anal canal in newborns with low imperforate anus is always normally formed up to the distal 3-5 mm, i.e. at the level of the skin and subcutaneous tissue of the perineum. Closed anal canal does not have any volume and it is not seen in the invertogram. The original method of X-Ray diagnosis of anorectal anomalies makes it possible to discover the anal canal if it exists. Operational findings can not be taken as a criterion for the correct diagnosis because rectal pressure decreases under the influence of anesthetics and the anal canal remains closed. A surgeon bypasses it and takes out the rectum instead. As a result, the muscles and neural connections of the anal canal and rectum are impaired. Then, patient is falsely diagnosed with high or intermediate imperforate anus which justifies the unsatisfactory functional results. Two methods of the operation are discussed here. They allow to utilize all elements of the anal canal that take part in the continence and defecation.

Keywords: imperforate anus, low anorectal anomalies, rectal atresia, newborn, bowel perforation, X-Ray diagnosis, invertogram, operation
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References
  1. Hashmi, M. A. Anorectal malformation in female children 10 years experience / M. A. Hashmi, S. Hashmi // J. R. Coll Surg. Edinb. 2000. Vol. 45, N 3. P. 153-158.
  2. Pena, A. Advances in the management of anorectal malformations / A. Pena, A. Hong // Am. J. Surg. 2000. Vol. 180, N 5. P. 370-376.
  3. Social quality of life for adult patients with anorectal malformations / N. Iwai [et al.] // J. Pediatr. Surg. 2007. Vol. 42, N 2. P. 313-317.
  4. Rectovaginal fistula: a common diagnostic error with significant consequences in girls with anorectal malformations / N. G. Rosen [et al.] // J. Pediatr. Surg. 2002. Vol. 37, N 7. P. 961-965.
  5. , . . : / . . , . . . ., 1970.
  6. Murugasu, J. J. A new method of roentgenological demonstration of anorectal anomalies / J. J. Murugasu // Surgery. 1970. Vol. 68, N 4. P. 706-712.
  7. Thompson, W. The association of spinal and genitourinary abnormalities with low anorectal anomalies (imperforate anus) in female infants / W. Thompson, H. Grossman // Radiology. 1974. Vol. 113, N 3. P. 693-698.
  8. Cremin, R. J. A rational radiological approach to the surgical correction of anorectal anomalies / R. J. Cremin, S. Cywes, J. H. Louw // Surgery. 1972. Vol. 71, N 6. P. 801-806.
  9. Analysis of 1,992 patients with anorectal malformations over the past two decades in Japan. Steering Committee of Japanese Study Group of Anorectal Anomalies / M. Endo [et al.] // J. Pediatr. Surg. 1999. Vol. 34, N 3. P. 435-441.
  10. Transperineal sonography for determination of the type of imperforate anus.AJR / H. P. Haber [et al.] // J. Am. J. Roentgenol. 2007. Vol. 189, N 6. P. 1525-1529.
  11. Niedzievlski, J. K. Invertography versus ultrasonography and distal colostography for the determination of bowel-skin distance in children with anorectal malformations / J. K. Niedzievlski // Eur. J. Pediatr. Surg. 2005. Vol. 15, N 4. P. 262-267.
  12. Pena, A. Management of anorectal anomalies during the newborn period / A. Pena // World J. Surg. 1993. Vol. 17, N 3. P. 385-392.
  13. McHugh, K. Pre-operative MRI of anorectal anomalies / K. McHugh // Pediatr. Radiol. 1995. Vol. 25, N 1. P. S33-36.
  14. Rectoperineal fistula in newborn boys / L. K. Shanbhogue [et al.] // J. Pediatr. Surg. 1994. Vol. 29, N 4. P. 536-537.
  15. By the Japan study group of anorectal anomalies. A group study for the classification of anorectal anomalies in Japan with comments to the International Classification (1970) // J. Pediatr. Surg. 1982. Vol. 17, N 3. P. 302-308.
  16. Gans, S. L. Congenital anorectal anomalies: changing concepts in management / S. L. Gans, N. B. Friedman, J. S. David // Clin. Pediatr. (Phila). 1963. Vol. 2. P. 605-613.
  17. , . . / . . // . 1983. 2. C. 49-52.
  18. US identification of the anal sphincter complex and levator ani muscle in neonates: infracoccygeal approach / T. I. Han [et al.] // Radiology. 2000. Vol. 217, N 2. P. 392-394.
  19. , . . / . . , . . , . . - // . 1985. 7. C. 38-44.
  20. , . . / . . , . . // . . . 2005. 2. C. 117-120.
  21. Anterior sagittal anorectoplasty for anorectal malformations and perineal trauma / A. Wakhlu [et al.] // J. pediatr. Surg. 1996. Vol. 31, N 9. P. 1236-1240.
  22. Watanabe, Y. Unexpectedly deformed anal sphincter in low-type anorectal malformation / Y. Watanabe, H. Takasu, K. Mori // J. Pediatr. Surg. 2009. Vol. 44, N 12. P. 2375-2379.
  23. Wajsman, Z. Rectal atresia / Z. Wajsman, J. A. Bar-Maor, S. Nissan // Harefuah. 1972. Vol. 83, N 9. P. 357-359.
  24. , . . / . . // . . 1989. 5. . 10-16.
  25. Intraoperative measurement of rectouretral fistula: prevention of incomplete excision in mail patients with high-type imperforate anus / H. Koga [et al.] // J. Pediatr. Surg. 2010. Vol. 45, N 2. P. 397-400.
  26. 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.
  27. Anorectal function and endopelvic dissection in patients with repaired imperforate anus / C. C. hen [et al.] // Pediatr. Surg. Int. 1998. Vol. 13, N 23. P. 133-137.
  28. Constipation is major functional complication after internal sphincter-saving posterior sagital anorectoplasty for high and intermediate anorectal malformations / R. Rintala [et al.] // J. Pediatr. Surg. 1993. Vol. 28, N 8. P. 1054-1058.
  29. deVries, P. A. Posterior sagittal anorectoplasty / P. A. deVries, A. Pena // J. Pediatr. Surg. 1982. Vol. 17, N 5. P. 638-643.
  30. Stevenson, R. J. Percutaneus transperineal pouch localization in low imperforate anus: a new approach / R. J. Stevenson, C. Sheldon, S. T. Ildstat // J. Pediatr. Surg. 1990. Vol. 25, N 2. P. 273-275.
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