Pathological physiology of the anorectal malformations without visible fistula. A short review.

Until 1982, pediatric surgeons came to a consensus that in patients with anorectal malformations (ARM), the intestine that is located caudal to the pubococcygeal line is the anal canal and, to achieve the best functional result, it must be preserved during surgery. Simultaneously with the publication of posterior sagittal anorectoplasty, it was stated that except for patients with rectal atresia and anal stenosis, patients with ARM are born without an anal canal. It is believed that the rectal pouch or fistula should be removed. We analyzed 41 articles, including 2 of our own studies, which reflect the entire palette of ideas about the pathological anatomy and physiology of ARM without a visible fistula (females and males without fistula and males with urethral fistula). On histological, manometric and radiological examinations, in most patients, the intestine located caudal to the PRM has the characteristics of a functioning anal canal. This literature review proves that most ARM patients without a visible fistula have a functioning anal canal, the preservation of which can ensure normal anorectal function. [ABSTRACT FROM AUTHOR]