IDENTIFYING SAFETY ANATOMICAL PARAMETERS OF PERIANAL SEGMENT IN RADICAL SURGICAL OPERATIONS FOR PILONIDAL DISEASE IN CHILDREN

Abstract

Pilonidal disease is a common pathology; the history of its investigating is quite long that can explain a large number of existing theories regarding its genesis and methods of correction. However, one of the best methods of performing radical surgery for pilonidal disease was the surgical intervention suggested by G.E. Karydakis in 1992. However, the lack of a clear anatomical reasoning for performing this surgery can lead to damage to important anatomical structures that are within the area of ​​surgery. Objective: to carry out detailed study at the microscopic level the structure of muscular tissues forming the internal and external sphincters of the rectum to provide anatomical grounds for selecting the techniques of radical surgery and to determine clear anatomical landmarks when performing surgical access. Materials and Methods: the study was performed on 10 corpses of children who had no any perianal and pelvic pathology in their lifetime. The age of children (5 girls and 5 boys) ranged from 12 to 17 years. Tissue samples were fixed in 10% neutral formalin solution for 24-48 hours and then dehydrated. Histological cross sections were stained with hematoxylin and eosin and by van Gieson technique. Results and discussion. The histological examination of the removed blocks of tissues located at 3`, 6`, 9` and 12` in the dorsal position revealed the main morphometric characteristics of the soft tissues of the perianal area with a targeted examination of the external sphincter of the anus. It has been established that the cross-sectional area of ​​the muscle bundles of the latter can vary significantly depending on the age and physique of the child. The spatial structure of the external sphincter of the anus has been described as well. According to morphometry, the latter is ellipse-shaped, elongated along the anterior-posterior direction with the centre displaced in the caudal direction relative to the anus. Conclusion. 1. The anatomical structure of the perianal area contains fibers of the external anal sphincter in the thickness of the subcutaneous fat, which can be damaged when performing radical surgery for pilonidal disease in children. 2. A detailed study of the anatomy of the perianal area enables to clearly identify the anatomical landmarks of the access edges in radical surgery for pilonidal disease in children. 3. The implementation of radical surgery for pilonidal disease in children requires more detailed study, since the empirical recommendations for their performing pose some risks of disruption of the normal body functioning due to damage to important anatomical structures of the perianal area. 4. The distal incision boundaries when removing the pilonidal cyst should be replaced not by 2 cm from the edge of the anal ring, but by 3 cm, as there is a risk of damage to part of the sphincter apparatus of the outlet.