[Imperforate anus. Principles and methods of surgical treatment]

Area of Science:

• Pediatric Surgery
• Anorectal Malformations
• Surgical Anatomy

Context:

• Imperforate anus surgery presents challenges beyond survival, focusing on achieving long-term fecal continence.
• Embryological insights have refined understanding of anorectal anomalies, influencing diagnostic and surgical strategies.
• A 1970 classification categorizes anomalies based on rectal position relative to the puborectalis muscle.

Purpose:

• To review the anatomical and physiological concepts guiding the diagnosis and surgical management of imperforate anus.
• To discuss the classification of anorectal anomalies based on the levator ani muscle.
• To highlight the surgical approaches and prognostic implications for different types of anorectal lesions.

Summary:

• Anorectal anomalies are classified as supralevator (high rectal lesions) or translevator (low anal lesions).
• Translevator lesions are treated with a perineal approach, offering an excellent prognosis.
• Supralevator lesions require a combined abdominoperineal operation, with continence prognosis remaining a challenge.

Impact:

• Improved surgical outcomes depend on a thorough understanding of anorectal anatomy and meticulous dissection of sphincteric muscles.
• This knowledge is crucial for optimizing functional results, specifically fecal continence, in patients with imperforate anus.
• Refined surgical techniques based on anatomical understanding can ameliorate long-term functional results.