Abdomino-Extended Sacroperineal Approach in High-Type Anorectal Malformation - and a New Operative Method

Single-stage repair for rectovestibular fistula without opening the fourchette

“…Stephens (1986) [14] laid maximum stress that the puborectalis sling is responsible for maintaining continence. Both Stephens and Rehbein did not give enough consideration to the external sphincter component, which was deliberately preserved by Yokoyama et al (1985) [15], in addition to using fibers of the internal sphincter. Pena (1985) [6] changed the concept of perineal musculature and postulated that instead of different muscle slings (ie, puborectalis), the perineal muscles were continuous, and the levators were joined to the external sphincter fibers with the help of the striated muscle complex.…”

Histopathologic and immunohistochemical findings in congenital anorectal malformations

“…Gans and Friedman [ 18 ] advocated preserving the rectal blind pouch based on its histology. Yokoyama et al [ 19 ] showed distinct thickening of the circular and longitudinal muscle layers in the distal rectal pouch in 2 neonates with high anal atresia. Meier-Ruge and Holschneider [ 17 ] observed hypoganglionosis of the myenteric plexus proximal to the anal floor, also most commonly in intermediate ARMs, which is therefore strongly recommended to be excised for reconstruction.…”

Histology with immunohistochemistry of the fistula region in female anorectal malformation: Can it be used for neo‐anus reconstruction?

“…Various researchers have noticed internal sphincter‐like structure in the fistula. It has been identified in the form of a longitudinal and circular layer or just a circular layer resembling a sphincter . Frenckner and Husberg believed that the fistula region contains a sphincter; hence, they preserved and transplanted to the neo‐anus with satisfactory results .…”