[The pathological physiology of the anorectal defects, from the new concept to the new treatment].

PURPOSE

To determine physiology of anorectal zone in norm and anorectal malformations (ARM) to optimize the surgical treatment.

MATERIAL AND METHODS

Examination of 119 patients were selected, including 65 children without anorectal pathology and 54 patients with ARM. We performed barium enema with radiopaque marker placed near the anus. The manometric study of anorectal area was done using intubation tube with an inflatable cuff.

RESULTS

The anal canal was detected in all of ARM patients with perineal and vestibular fistulas, as well as in most of the newborns without fistula. The well innervated internal anal sphincter (IAS) was located in the loop of the puborectal muscle (PRM) and connected to the levator ani muscle (LAM) which opens the anal canal during defecation. Anterior and posterior sagittal approaches use IAS excision, with PRM damage and cutting off the LAM from IAS, which leads to incontinence and/or chronic constipation.

CONCLUSION

We describe two surgical approaches that allow preservation of all elements of the anal canal resulting in a normal post-operative continence and defecation.