Novosti
Khirurgii

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Year 2023 Vol. 31 No 5

REVIEWS

M.D. LEVIN

THEORETICAL BASIS OF NEW SURGICAL TACTICS FOR ANORECTAL DEFECTS WITHOUT VISIBLE FISTULAS

X-ray Department of the 1st City Clinical Hospital, Minsk,
Republic of Belarus,
Dorot. Medical Center for rehabilitation and geriatrics. Netanya,
Israel

Recently, the diagnosis and surgical treatment of anorectal malformations (ARM) is based on the idea of the absence of the anal canal in these patients. The caudal part of the intestine, called the fistula or rectal pouch, is removed during all pull-through procedure. Poor results from these surgeries (fecal incontinence 16.7% to 76.7%; chronic constipation 22.2% to 86.7%; urinary incontinence 1.7% to 30.5%; ejaculatory dysfunction 15.6% to 41.2%; and erectile dysfunction 5.6% to 11.8%) are explained by the congenital absence of the anal canal. In the previous articles, we proved that these patients have a normally functioning anal canal. This was confirmed by the European Consortium. This paper provides a theoretical justification for new surgical interventions that preserve all the elements of the anal canal to exclude severe complications during ARM correction. In newborns, we offer a perineal perforation (PPP) procedure by inserting a needle into an open anal canal. The opening of the anal canal is performed under X-ray control due to compression of the abdomen. As a result of simple manipulations, a tracheostomy tube is inserted into the rectum, which is removed after 7 days. Diastasis between the intestine and the skin heals without the formation of fibrous tissue since there are no sutures between the intestine and the skin. In the presence of a colostomy, we recommend the method proposed by Pakarinen and Rintala. The anal canal is visualized within the intestinal lumen using retrograde flexible endoscopy through a previously performed sigmoid mucosal fistula. Perforation of the skin and subcutaneous tissue is performed with a special endoscope needle. After the same manipulations as in PPP, a tracheostomy tube is inserted into the rectum. Fecal retention and defecation did not differ from the norm after the use of PPP in several patients. This work substantiates the opportunity for clinical trials of the proposed methods.

Keywords: anorectal malformations without visible fistula; anal canal; X-ray diagnosis; surgical treatment; perineal perforation procedure; colostomy
p. 397-404 of the original issue
References
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Address for correspondence:
4220200, Dorot,
Amnon ve-Tamar 1, Israil
State Geriatic Center, Netanya,
tel.: +972 538281393,
e-mail: nivel70@hotmail.com,
Levin Mikhail D.
Information about the authors:
Levin Mikhail D. MD, Radiologist, State Gerriatric Center (Djrot), Netanya, Israil.
https://orcid.org/0000-0001-7830-1944
Contacts | ©Vitebsk State Medical University, 2007-2023