Year 2022 Vol. 30 No 3


M.D. LEVIN 1, 2, V.I. AVERIN 1, 3, YU.G. DEGTYAREV 1, 3


State Institution "Republican Scientific and Practical Center for Pediatric Surgery" ¹, Minsk,
Republic of Belarus
Dorot. State Geriatric Center, Netanya, Israel ²,
EE "Belarusian State Medical University" ³, Minsk,
Republic of Belarus

Objective. Until 1982, pediatric surgeons came to the consensus that in patients with anorectal malformations (ARM), the intestine located caudal to the pubococcygeal line is the anal canal and must be preserved to achieve the best functional result. Simultaneously with the publication of the posterior sagittal anorectoplasty, it was stated that most patients with ARM do not have anal canal. The part of the intestine that is located caudal to the pubococcygeal line began to be called the rectal sac or fistula, which was recommended to be removed, since it was believed that it was not functioning well. Analysis of the literature to determine the anatomy and physiology of ARM without visible fistulas.
Methods. The authors analyzed 32 articles, including 4 of own studies, which reflect the entire palette of ideas about the pathological anatomy and physiology of ARM without visible fistula (boys and girls without fistula, and boys with urethral fistula).
Results. During histological examination of the so-called fistula, the internal anal sphincter and the mucous membrane characteristic of the anal canal are determined. In a manometric study, the normal basal pressure and the rectoanal inhibitory reflex are determined. In radiological studies, in most patients at rest, the distal colon is constantly in a contracted state and opens wide at high pressure in the rectum, which is characteristic of a normally functioning anal canal.
Conclusion This literature review proves that most ARM patients without visible fistula have a functioning anal canal that must be preserved to support normal anorectal function.

Keywords: anorectal malformations; anorectal physiology; pathophysiology anorectum; urethral fistula; without fistula
p. 298-305 of the original issue
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Address for correspondence:
4220200, Dorot.
State Geriatric Center, Netanya,
Amnon ve-Tamar 1, Israel.
. 972-53-8281393,
Levin Michael
Information about the authors:
Levin Mikhail D., MD, Radiologist, State Geriatric Center (Dorot), Netanya, Israel.
Averin Vasily I., MD, Professor, Head of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus,
Degtyarev Yury G., MD, Professor of the Department of Pediatric Surgery Belarusian State Medical University, Minsk, Republic of Belarus
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