Anorectal Research Articles

The cloacal anomalies: Anatomical insights through a complex spectrum

PurposeTo study the detailed anatomy of cloacal anomalies using the multiplanar capabilities of MRI in addition to other available modalities. Patients and methodsThe study was conducted on 27 cases of cloaca that were managed at our unit during the last 12 years. Preoperative assessment included conventional investigations and MRI studies. Endoscopic and operative findings were important for confirmation and completion of the whole picture.For better perception of the degree of deviation from the norm, we included another control group of girls who underwent pelvic MRI studies for causes other than anorectal anomalies. ResultsFor practical reasons, we dissociated the cloacal complex into its two basic components to be described separately namely the anorectal anomaly and persistent urogenital sinus.The anorectal anomaly may be best described regarding two parameters: the position of the rectum and type of rectal communication with the urogenital tract.Persistent urogenital sinus anomalies were stratified based on referring the level of the urogenital confluence to the back of pubic symphysis. Three types could be identified (low, intermediate, and high) in which the mean length of the common channel was 6.4, 14.6, and 24 mm respectively with a significant statistical difference (Kruskal–Wallis chi-squared test). ConclusionApplying MRI in the preoperative assessment of cases of cloaca has the advantage of demonstrating the real anatomy of the anomaly in multiple planes. This can improve our perception of the degree of deviation from the norm in these cases, which may be important during planning for surgical reconstruction. Level of evidenceThis is a case control study (level III evidence).

Effects of acupoints moxibustion on urination among patients with selective mucosectomy

Objective To explore the effects of acupoints moxibustion on urination among patients with selective mucosectomy. Methods From February 2015 to February 2018, we selected 100 hemorrhoids patients in anorectal surgery at Zhejiang Provincial Hospital. All of the patients were randomly divided into experimental group and control group with the randomization scale produced by SPSS 17.0, 50 cases in each group. Control group implemented routine nursing. On the basis of routine nursing, experimental group carried out acupoints moxibustion. We observed the first urination time, volume of the first urination and maximal urinary flow rate of patients between two groups. Results There was no statistical difference in the volume of the first urination of patients between two groups (P>0.05) . There were statistical differences in the first urination time, maximal urinary flow rate of the first urination and the rate of catheterization (P<0.05) . Conclusions Acupoints moxibustion can reduce the first urination time, improve maximal urinary flow rate of the first urination, and decrease the rate of catheterization among patients undergoing selective mucosectomy to improve urination which is worth to be widely generalized in clinic. Key words: Hemorrhoids; Tissue selecting technique; Acupoint moxibustion; Urination time; Maximum urinary flow rate

Clinical analysis of rectal bleeding after anorectal operation

Objective To study the cause and outcome measures of rectal bleeding after anorectal surgery. Methods From January 2016 to December 2016, 60 patients with rectal bleeding after anorectal surgery in Yuncheng Central Hospital were selected.The bleeding phenomena in these patients were analyzed. Results After anorectal surgery, the rectal hemorrhage rates of anterior sphincter rectal polypectomy, rectal abscess incision drainage, anal fistula incision operation, mixed hemorrhoid external strip were 6.67%(1/15), 14.29%(1/7), 7.41%(2/27), 9.09%(1/11), respectively.The rectal bleeding rate of anorectal surgery was 8.33%(5/60). Conclusion The effective preventive measures can effectively reduce the probability of postoperative rectal bleeding in patients with anorectal surgery. Key words: Digestive system surgical procedures; Intestinal polyps; Abscess; Rectal fistula; Anorectal surgery(TCM); Gastrointestinal hemorrhage

Megarectosigmoid in anorectal malformations: the role of laparoscopic resection.

Surgical treatment for anorectal malformations may lead to chronic constipation or stool incontinence. The first condition is mostly linked to an abnormal dilation of rectum and sigma and it is primarily managed with medical therapy (laxatives, diet and enemas). When medical therapy fails to improve the symptoms, a surgical resection of the dilated colon is advocated. When performing the procedure it is mandatory to consider all the previous operations the patient undergone. We present a laparoscopic left emicolectomy for an extremely dilated megarectosimoid after posterior sagittal anorectoplasty in childhood for a recto-urethral fistula. (www.actabiomedica.it)

Evaluation of the functional outcome of the neonatal one stage posterior sagittal anorectoplasty (PSARP) as a procedure to treat cases of high anorectal malformation in male neonates

Background: Male anorectal malformations have many varieties, from simple types that can be easily repaired in one stage to more complex cases that need more sophisticated repairs in a staged approach. The staged approach has higher morbidity than the one-stage approach and includes colostomy complications, risk of repeated anesthesia and surgery, high costs and psychological and psychological burden on parents. Based on these disadvantages of the staged posterior sagittal anorectoplasty (PSARP) for high anorectal malformations, one-stage neonatal PSARP has been developed. The aim of our work is to evaluate the functional and clinical outcome of the one-stage approach in the treatment of selected cases of male neonates with high anorectal malformations Material and methods: This is a retrospective study which included male patients who had neonatal one-stage PSARP for their high anorectal anomalies between 2006 and 2013. Inclusion criteria included patients with flat or mildly distended abdomen; those in whom the cross-table film of the abdomen showed the rectal pouch reaching down to the fifth sacral segment and patients passing meconium from the urethra. However, cases with complete sacral agenesis, major cord anomalies, and a markedly distended abdomen—possibly due to a megarectum—were excluded from the selection. Patients were evaluated for their functional and clinical outcome at the time of the follow-up in January 2018. Patients with poor outcomes were further evaluated by MRI and examination under anesthesia. Results: Our retrospective study included 24 patients with an age range between 5 and 11 years at the time of follow up in January 2018. 16 patients had a recto-bulbar fistula, six patients had a recto-prostatic fistula, and only two patients had recto-bladder neck fistula. According to the continence outcome, 15 patients had a good outcome, all of which had a recto-bulbar fistula. Six patients had a fair outcome; 5 of them had a recto-prostatic fistula, and only one patient had a rectobulbar fistula. The remaining three patients who had poor outcome included all patients with recto-bladder neck fistula (2 patients) and one patient with recto-prostatic fistula; this was statistically significant (P

Anorectal sexually transmitted infections. An infradiagnosticated epidemic

Anorectal sexually transmitted infections. An infradiagnosticated epidemic

Histomorphological changes and expression of neuron-specific enolase, S-100 protein and c-kit in the terminal rectums in patients with high and intermediate anorectal malformation

Objective To investigate the morphological changes and development of enteric nerve in terminal rectums in patients with high and intermediate anorectal malformations (ARMs), and to explore the mechanism of bowel dysfunction postoperatively. Methods The hematoxylin and eosin (HE), Masson staining, IHC and Western blotting were used to evaluate the terminal rectums in patients with ARMs and healthy controls. Results Compared with the normal group, the most frequently observed histological finding in mucosa was inflammation and ulcer, submucosal congestion was the most common finding, disrupted muscularis propria and fibrosis was common. The number of submucosal and myenteric plexus also reduced significantly in ARMs group compared with controls (5.30±1.26 vs. 1.20±0.73, P=0.007). The expression levels of neuron-specific enolase (NSE), S-100, and c-kit in ARMs group were significant lower than that in normal group (NSE: 0.510±0.033 vs. 0.476±0.036; S-100: 0.445±0.009 vs. 0.420±0.012; c-kit: 0.982±0.043 vs. 0.756±0.017; P=0.023, 0.035, 0.028, respectively). Conclusion The terminal rectums in ARMs show various specific and non-specific histomorphological changes, along with ganglion cell dysplasia and aganglionosis and reduction of density and distribution of ICC. These findings maybe responsible for the defecation dysfunction after anorectoplasty. Key words: Anorectal malformation; Immunohistochemical staining; Western blotting

Hidden spinal dysraphism in the structure of osteoneural spine anomalies in children

Despite the long-term study of the problem of spinal dysraphism, its relevance is associated with a high frequency of children born with this disease and long-term effects that have medical-social value. In verified materials there are 144 sick children with osteoneural myelopathy assessed the frequency and characteristics of existing neurological disorders in hidden spinal dysraphism. Found that a combination of high MICs with urogenital and anorectal anomalies contribute aggravation of their flow.

Associated anomalies in cases with anorectal anomalies.

Anorectal anomalies (ARA) are common congenital anomalies. The etiology of ARA is unclear and its pathogenesis is controversial. Cases with ARA often have other non-ARA-associated congenital anomalies. The purpose of this study was to assess the prevalence and the types of these associated anomalies in a defined population. The associated anomalies in cases with ARA were collected in all live births, stillbirths, and terminations of pregnancy during 29 years in 387,067 consecutive births in the area covered by our population-based registry of congenital malformations. Of the 202 cases with ARA, representing a prevalence of 5.21 per 10,000, 100 (49.5%) had associated anomalies. There were 7 (3.3%) cases with chromosomal abnormalities, and 31 (15.3%) nonchromosomal recognized dysmorphic conditions, including 17 cases with Vertebral defects, Anal atresia, Cardiac septal defects, esophageal atresia or TracheoEsophageal fistula, Renal anomalies and radial Limb defects association. Sixty two (30.7%) of the cases had nonsyndromic multiple congenital anomalies (MCA). Anomalies in the urogenital, the musculoskeletal, the cardiovascular, the digestive, and the central nervous systems were the most common other anomalies in the cases with MCA. The anomalies associated with ARA could be classified into a recognizable malformation syndrome or pattern in 38 out of the 100 cases (38%) with associated anomalies. This study included special strengths: each affected child was examined by a geneticist, all elective terminations were ascertained, and the surveillance for anomalies was continued until 2 years of age. In conclusion, the overall prevalence of associated anomalies, which was close to one in two cases, emphasizes the need for a routine screening for other anomalies in cases with ARA.

Effect of laser acupuncture on fecal incontinence after anorectal surgery

Fecal incontinence (FI) is considered a common complication after anorectal surgeries because of sphincter injury. Application of laser acupuncture (LA) on acupoints is a noninvasive modality that may assist in the treatment of FI and in decreasing the frequency of incontinence. This study investigated the effect of laser stimulation to acupoints on anal pressure during rest and squeeze, and the frequency and consistency of defecation in FI after anorectal surgery. This study was carried out as a randomized-controlled trial of 40 patients (17 men and 23 women) diagnosed with moderate FI after anorectal surgery. The ages of the patients ranged from 40 to 70 years. They were assigned randomly to two equal groups: the experimental (LA) group, which received 60 s laser stimulation for acupuncture points plus pelvic floor exercises three sessions per week for 4 weeks, and the control (placebo) group, who received sham LA plus pelvic floor exercises three sessions per week for 4 weeks. Anorectal manometry was used to measure resting anal pressure and squeeze anal pressure. The frequency of FI was measured using the FI severity index. Assessment was carried out before and after 1 month of treatment. The results showed that there was a significant increase in resting anal pressure and squeeze anal pressure of the study group compared with that of the control group after treatment (P> 0.001). Also, there was a significant decrease in the fecal incontinence severity index of the study group after treatment compared with that of the control group (P>0.001). It was concluded that stimulation of laser to acupuncture points for 4 weeks is an effective approach for FI after anorectal surgery.

Pelvic floor function in women with stress urinary incontinence

Objective To evaluate any changes in overall pelvic floor function among women with stress urinary incontinence (SUI). Methods Twenty-five female SUI patients were recruited as the SUI group and twenty-three healthy female counterparts were selected as the control group. Pelvic organ prolapse quantification (POP-Q) was performed with both groups. Ultrasonography was used to measure the position of the bladder neck, the posterior angle of the urethra, the urethra′s inclination angle and the size of the diaphragmatic hiatus for both groups at rest, during the Valsalva maneuver, as well as during the transition from resting to the Valsalva maneuver. The strength and fatigue of type I and type II fibers in the pelvic muscles were evaluated electrophysiologically, and anorectal manometry was also performed with both groups. The significance of any relationship between these measurements and SUI was determined using multivariate logistic regression analysis. Results Eleven members of the SUI group showed phase I pelvic organ prolapse. Twelve were in phase II and 2 were in phase III. All of those incidences were significantly different from the control group. There were significant differences between the two groups in the average bladder neck position, urethral inclination angle, posterior urethra angle, descending distance of the bladder neck, and urethral rotation angle during the Valsalva maneuver. In the transition from resting to the Valsalva maneuver, significant differences were found only in the distance of the bladder neck′s descent and the rotation angle of the urethra. The severity of pelvic organ prolapse, the descending distance of the bladder neck and the urethral rotation angle, as well as the bladder neck position and urethral angle during the Valsalva maneuver were the major risk factors associated with female SUI, and the correlation was statistically significant. Conclusion The greater the mobility of the bladder neck and urethra in female SUI patients, the more serious the prolapse. Prolapse, bladder neck mobility and urethral support all affect the overall functionality of the pelvic floor. Key words: Stress; Urinary incontinence; Pelvic floor; Ultrasonography; Anorectal manometry

Consistency between symptoms and colorectoanal function tests in elderly patients with functional constipation

Objective To analyze the consistency between constipated symptoms and the parameters of gastrointestinal transit time (GITT), anorectal manometry (ARM) in elderly patients with functional constipation. Methods Total 111 patients (54 males and 57 females) with an average age of (70.2±6.5) years, who met Rome Ⅲ criteria of functional constipation were enrolled from June 2010 to October 2012. After enrollment, patients took two-week diary, recording the spontaneous bowel movements per week, stool type of Bristol Stool Form, the frequency and severity of defecation straining, sensation of anorectal obstruction, manual maneuvers and sensation of incomplete evacuation. The GITT and ARM tests were performed, and the consistency between symptoms and test results were analyzed. Results Patients with symptoms of slow transit, defecation disorder and mixed symptoms were 19.8% (22/111), 16.2% (18/111) and 59.5% (66/111) respectively; and 4.5% (5/111) patients had scattered symptoms. Based on results of GITT, slow transit subtype, defecation disorder subtype and mixed subtype were 54.1% (59/109), 1.8% (2/109) and 29.4% (32/109) respectively; and 14.7% (16/109) patients were with normal transit time. ARM results showed that 38.0% (41/109) of patients had dyssynergic defecation. The percentage of slow transit in GITT test showed no significant difference between patients with slow transit symptoms and mixed symptoms[50.0% (11/22) vs. 57.9% (33/57) , χ2=0.401, P=0.527]. The consistency of predominant symptom with GITT subtype was low (к=-0.013). The percentage of dyssynergic defecation detected with ARM showed no significant difference between patients with defecation disorder-predominant symptom and with mixed symptom [23.1% (6/24) vs. 38.2% (21/55) , χ2=1.813, P=0.178]. The consistency of defecation disorder-predominant symptom with dyssynergic defecation in ARM was low (к=-0.019). Conclusion The mixed subtype symptoms are the most common presentations of elderly patients with functional constipation, and the consistency of predominant constipated symptoms with GITT, ARM test results is poor. Key words: Aged; Constipation; Gastrointestinal transit; Anorectal manometry

Obstetrical Outcomes in Adult Patients Born with Complex Anorectal Malformations and Cloacal Anomalies: ALiteratureReview.

Patients born with complex anorectal malformations often have associated Müllerian anomalies, which might affect fertility and obstetrical outcomes. Other vertebral-anorectal-tracheoesophageal-renal-limbassociations, such as renal or cardiac anomalies, could also affect pregnancy intention, fertility rates, and recommendations about mode of delivery or obstetrical outcomes. Associated conditions present at birth, like hydrocolpos, could also potentially affect fertility. Depending on the complexity of the anomaly, primary reconstruction might include vaginoplasty, vaginal interposition, perineal body reconstruction, and extensive pelvic dissection. After the initial reconstruction, patients might have multiple additional surgeries for stoma reversal, bladder augmentation, and creation of conduits, all with potential for pelvic adhesions. Pregnancy intention, fertility rates, mode of delivery, and obstetrical outcomes data are limited in this patient population, making it challenging to counsel patients and their families. We sought to evaluate all available literature in an attempt to better counsel families. A PubMed literature search was undertaken to review this topic. Search terms of "cloaca," "anorectal malformation," "pregnancy," "cloacal exstrophy," "vaginal delivery," and "cesarean section" were used and citation lists from all identified articles were checked to ensure that all possible articles were included in the review. We also outline comorbidities from the fetal period to adulthood that might affect reproductive health. Of the articles on anorectal and cloacal anomalies, 13 reports were identified that covered obstetrical outcomes. They were in patients with previous anorectal malformation, cloaca, and cloacal exstrophy repair. Twenty-four pregnancies were reported in 16 patients. Two ectopic pregnancies, 5 spontaneous miscarriages, 1 triplet pregnancy, and 16 singleton pregnancies were reported with a total of 19 live births. Regarding the method of conception, 15/18 pregnancies occurred spontaneously and 3/18 were via assisted reproductive technology with invitro fertilization. There were 19 live births, of which at least 8 were preterm. Müllerian anatomy was reported in 8 of 13 articles. Only 2 patients underwent vaginal delivery (1 patient with repaired cloaca malformation had an operative vaginal delivery and 1 patient with repaired imperforate anus with rectovaginal fistula had a normal spontaneous vaginal delivery). The remaining patients all underwent a cesarean section. There were no reported cases of maternal mortality, and maternal morbidity was limited to recurrent urinary tract infections and worsening chronic kidney disease. There is a paucity of information regarding obstetrical outcomes in adult anorectal and cloaca patients. However, patients with previous cloacal repairs have achieved pregnancy spontaneously, as well as with invitro fertilization. Patients with repaired cloacal malformations are at increased risk of preterm birth and cesarean delivery. Most patients with cloacal anomalies have an associated Müllerian anomaly and therefore have an increased risk of preterm labor. From our review we conclude that contraception should be offered to patients not desiring pregnancy, and cesarean section is likely the preferred mode of delivery. On the basis of this review, we recommend proactive data collection of all such patients to document outcomes and collaboration among providers and between centers devoted to this complex patient population.

Laparoscopically Assisted Anorectoplasty for Intermediate-Type Imperforate Anus: Comparison of Surgical Outcomes with the Sacroperineal Approach.

Aim: This study aimed to compare the surgical outcomes of patients with the intermediate-type imperforate anus who underwent laparoscopically assisted anorectoplasty (LAARP; L group) with those of patients who underwent sacroperineal anorectoplasty (S group). Materials and Methods: The medical records of patients with intermediate-type imperforate anus at a single institution between April 1983 and April 2017 were retrospectively reviewed. Fecal continence was evaluated using the clinical assessment score for fecal continence developed by the Japanese Study Group of Anorectal Anomalies (maximum score, 8). Results: Twelve cases (rectobulbar urethral fistula, 7; anal agenesis without fistula, 4; and rectovaginal fistula, 1) were included in the L group versus 14 cases (rectobulbar urethral fistula, 11, and anal agenesis without fistula, 3) in the S group. Age and body weight at the time of surgery and rate of associated anomalies did not differ significantly between the two groups. The total scores for fecal continence 3, 5, and 7 years after anorectoplasty were 4, 5, and 4 points in the L group and 4, 5, and 6 points in the S group, respectively, showing no significant intergroup differences. Mucosal prolapse occurred in 50% of the L group and 29% of the S group (P = .42), but failed rectocutaneous anastomosis and anal stenosis were not identified in either group. Conclusions: Postoperative fecal continence and the incidence of complications after LAARP were comparable with those after sacroperineal anorectoplasty in patients with intermediate-type imperforate anus.

Anorectal dynamics of Bu-Zhong-Yi-Qi decoction with biofeedback therapy for fecal incontinence after anus-preserving surgery in patients with low rectal cancer

Objective To evaluate the effect and mechanism of Bu-Zhong-Yi-Qi decoction with biofeedback therapy on defecation dysfunction after anus-preserving surgery in patients with low rectal cancer through anal defecation function and anorectal dynamic indexes. Methods 120 patients with low rectal cancer preparing for anterior resection were randomized for three groups (45 cases of groups A and B, and 30 cases of group C). Group A was treated with Bu-Zhong-Yi-Qi decoction with biofeedback therapy for 3 months after the operation, group B was only treated with biofeedback, and group C was not given special treatment. Before operation, 2 weeks after operation and 2, 6, 10 and 14 months after intervention, the indexes about the change of defecation function and anorectal dynamics were continuously observed. Results There was no significant difference between group A and group B at 14th month after intervention in anal canal resting pressure (t=1.467, P=0.146), maximum anal canal systolic pressure (t=0.774, P=0.441), rectal threshold sensory capacity (t=1.856, P=0.067), rectal sense of sensory capacity (t=1.498, P=0.138) and rectal maximum tolerance (t=0.893, P=0.374), and those were (47.8±8.3), (188.8±19.2) mmHg (1 mmHg=0.133 kPa), (22.4±4.5), (48.1±9.9), (187.4±25.8) ml in group A. As compared with group C, the resting pressure of anal canal (t=10.018, P=0.000), the maximum systolic pressure of the anal canal (t=15.460, P=0.000) and the maximum rectal tolerance (t=12.835, P=0.000) at 14th month after treatment were significantly increased in group A , while the rectal threshold sensory capacity (t=1.546, P=0.127) and the rectal defecation capacity (t=1.754, P=0.084) showed no statistically significant difference between group A and group C. As compared with group C, the resting pressure of the anal canal (t=9.239, P=0.000), the maximum systolic pressure of the anal canal (t=16.543, P=0.000) and the maximum rectal tolerance (t=11.995, P=0.000) were significantly increased in group B [(45.2±7.6), (185.8±15.8) and (182.4±26.5) mmHg], and the rectal threshold sensory capacity (t=-0.009, P=0.993) and the rectal defecation capacity (t=0.476, P=0.636) showed no statistically significant difference [(20.6±4.4) and (44.9±9.9) ml]. In groups A and B, the number of patients with defecation function in general (6-5 points) and poor (less than 4 points) at 14th month after treatment was significantly increased as compared with that before treatment (χ2=13.105, P=0.000; and χ2=14.419, P=0.000, respectively) and in group C (χ2=15.238, P=0.000; χ2=14.364, P=0.000, respectively). There was no significant difference between group A and group B (χ2=0.025, P=0.874). Conclusion Bu-Zhong-Yi-Qi decoction with biofeedback therapy can effectively treat the defecation dysfunction after anus preserving operation in patients with low rectal cancer, mainly by tonifying Qi, invigorating splenic yang, and accelerating the recovery of anal sphincter function. Key words: Bu-Zhong-Yi-Qi decoction; Biofeedback therapy; Low rectal caicinoma; Fecal incontinence

Prognostic factors and incidence of primary mucosal melanoma: a population-based study in France.

Few population-based studies on the incidence and prognosis of primary mucosal melanoma (PMM) are available. The first objective was to evaluate disease-specific survival of PMM, overall and according to specific locations, and to identify prognostic factors. The second objective was to assess the global incidence of PMM compared to cutaneous melanoma and to specify the relative frequency of each affected location. A retrospective population-based study of incident PMM diagnosed between 2004 and 2014 was conducted, relying on the regional melanoma registry of the French Champagne-Ardenne region (1.34 million inhabitants). Thirty-nine cases were identified, including 17 head and neck (13 sinonasal and four oral), 12 vulvovaginal, six conjunctival, and four anorectal PMMs. Some 76.9% of cases were revealed by late symptoms. The median disease-specific survival time was 23.9 months and the five-year disease-specific survival rate was 31.8%. Univariate and multivariate analyses led to identification of primary tumour size and the presence of nodal or visceral macrometastases at diagnosis as adverse prognostic factors, while Breslow thickness and ulceration were unreported in 41% of cases and failed to display any prognostic value. Compared to other locations, conjunctival PMMs had a smaller tumour size and better prognosis. The annual incidence rate was 0.18/100,000 and the incidence ratio between PMM and cutaneous melanoma was 1/50. This population-based study confirms the rarity, delayed diagnosis, and severity of PMM, suggesting that improving prognosis will require specific, targeted therapies.

Association of teratoma of vulva with anorectal anomaly: prenatal diagnosis

The article presents a case of prenatal diagnosis of a vulvar teratoma in a fetus in gestation period of 33 weeks. After birth, also detected atresia of the rectum and anus. In the neonatal period, the girl successfully underwent surgery to remove the tumor-like formation of the vulva and recto-vaginal plasty. The tumor in the pathomorphological study was identified as a mature teratoma. At the age of 2,5 years the child develops according to age standards.

Presacral tumors of the Currarino triad: teratomas or hamartomas?

Purpose: The aim was to elucidate the nature of the presacral tumors in the Currarino triad through studying their preoperative radiological anatomy and histopathology of excised specimens.Patients and methods: The study group included three operated cases of Currarino triad. All were women who presented with constipation and demonstrated the typical three components of the disease: anorectal anomaly, sacral bony defect, and presacral tumor. The histopathological slides of excised specimens (presacral tumors) were available for re-examination. For comparison, we included another ‘control’ group representing the standard sacrococcygeal teratomas (without vertebral or anorectal anomalies).Results: Histopathological examination of presacral tumors in the Currarino triad showed multicystic spaces lined by different types of epithelia mainly keratinized stratified squamous epithelium with focal areas of transitional epithelium. The underlying stroma showed fibrovascular connective tissue admixed with randomly arranged smooth muscle bundles. In contrast to the standard sacrococcygeal teratomas, neither skin adnexal structures nor heterologous mesenchymal tissues were observed; no immature elements could be detected.Conclusion: In the Currarino triad, several clinical and histopathological observations would suggest the excised presacral tumors to be developmental cysts (retrorectal hamartomas) rather than neoplastic teratomas.Keywords: Currarino triad, hamartoma, sacrococcygeal, tailgut, teratoma

Tunnel fistulectomy with multiseton drainage in treatment of complicated anal fistula

Seventy seven patients with complicated anal fistula were randomly assigned to receive tunnel fistulectomy with multiseton drainage (group A, n=38) or traditional fistulectomy (group B, n=39) for treatment.The clinical data and the treatment outcomes of two groups were compared.There was no significant difference in operation time between two groups (P>0.05). However, group A was significantly superior to group B in postoperative pain Numerical Pain Rating Scak (NPRS) score [(2.2±0.84) vs. (4.2±1.3), P<0.05)], wound surface area [(3.7±0.84) cm2vs. (7.28±1.83) cm2,P<0.05], wound healing time [(23.4±2.41) d vs. (38.8±3.49) d, P<0.05 ], cure rate(97.4% vs. 79.5%, P<0.05) and recurrent rate 1 year after surgery(5.3% vs. 25.6%, P<0.05). The postoperative anorectal dynamic parameters of group A were also better than those of group B (P<0.05). Compared to traditional fistulectomy, the tunnel fistulectomy with multiseton drainage has advantages of less pain, faster recovery, less disturbance in anal function and better long-term clinical effect in treatment of complicated anal fistula. Key words: Rectal fistula; Surgical procedures, minor; Drainage; Thread-ligating therapy

Association Between Exstrophy-epispadias Complex And Congenital Anomalies: A German Multicenter Study

ObjectiveTo further investigate associated anomalies in exstrophy-epispadias complex (EEC) patients congenital uro-rectal malformations network (CURE-Net) database was systematically screened. In literature the EEC comprises a spectrum of anomalies, mainly occurring “isolated” without additional congenital defects. Nevertheless, previous epidemiological studies indicated a higher association with renal, anorectal, and lower neurotubular anomalies, which may originate from the same developmental morphogenetic fields. Materials and MethodsSeventy-three prospectively (born since 2009) and 162 cross-sectional recruited EEC patients (born 1948-2008) were analyzed. Associated anomalies were derived from patient's medical data as well as from a physical examination during a physician's interview, classified according to the international statistical classification of diseases and related health problems and grouped with the London Dysmorphology Database. Descriptive statistical analyses were performed. ResultsMajority of participants were male (68%) and expressed the classical bladder exstrophy phenotype (71%). Exstrophy variants occurred significantly more often in newborns (21%, P < .0001). Anomalies such as inguinal hernias, skeleton, and joint anomalies were equally present in both groups (P = .65 and P = .67). Heart defects were seen more often in newborns (6%) than in the cross-sectional group (1%; P = .033) and the general German population (1%). In total, 59% of the prospective and 48% of the cross-sectional patients had associated anomalies outside the spectrum (P = .16). ConclusionPhenomenological multicenter data confirmed the dimension of associated anomalies inside and outside the EEC spectrum. The detected anomalies are either important in preparing for the primary reconstruction or later in long-term follow-up. Associated anomalies of EEC should be spotlighted during routine check-up in all EEC patients.