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Rethinking Fistula Preservation in Anorectal Malformation Surgery: A Histopathological Perspective
Preeti Agarwal1, Shubhajeet Roy2, Anand Pandey3
1Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Summary
Histopathological analysis of anorectal malformation (ARM) fistula tissue in males reveals absence of normal anal structures and presence of fibrosis and metaplasia. This suggests potential for abnormal bowel function if used for neoanus construction, impacting quality of life.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Histopathology
Background:
- Anorectal malformation (ARM) presents complex surgical challenges.
- Recto-urethral fistula is a specific ARM subtype requiring careful management.
- Neoanus construction aims to restore bowel continuity and function.
Purpose of the Study:
- To histopathologically evaluate fistulous tissue in male ARM patients with recto-urethral fistula.
- To determine the suitability of this tissue for neoanus construction.
Main Methods:
- Prospective observational study of male ARM patients with recto-urethral fistula.
- Histological examination of rectal pouch and fistulous tissue using Hematoxylin and eosin staining.
- Evaluation of key histological features: internal sphincter, anal glands, crypts, ganglion cells, fibrosis, nerve trunks, and metaplasia.
Main Results:
- Internal anal sphincter was absent in all samples.
- Abnormalities in crypt architecture were observed in 16.67% of samples.
- Urothelial metaplasia was present in 41.67% of samples.
- Adequate ganglion cells were found in only 25% of samples.
- Significant submucosal fibrosis was universally present.
- Thickened nerve trunks were identified in 16.67% of samples.
Conclusions:
- Fistulous tissue in male ARM patients lacks essential normal anal histological features.
- Abnormal features like fibrosis, thickened nerve trunks, and metaplasia are prevalent.
- Utilizing this tissue for neoanus construction may lead to impaired bowel function (e.g., constipation) and reduced quality of life.
