title: [The pathological physiology of the anorectal defects, from the new concept to the new treatment].
abstract: OBJECTIVE
  To determine physiology of anorectal zone in norm and anorectal malformations (ARM) to optimize the surgical treatment.
  
  
  METHODS
  Examination of 119 patients were selected, including 65 children without anorectal pathology and 54 patients with ARM. We performed barium enema with radiopaque marker placed near the anus. The manometric study of anorectal area was done using intubation tube with an inflatable cuff.
  
  
  RESULTS
  The anal canal was detected in all of ARM patients with perineal and vestibular fistulas, as well as in most of the newborns without fistula. The well innervated internal anal sphincter (IAS) was located in the loop of the puborectal muscle (PRM) and connected to the levator ani muscle (LAM) which opens the anal canal during defecation. Anterior and posterior sagittal approaches use IAS excision, with PRM damage and cutting off the LAM from IAS, which leads to incontinence and/or chronic constipation.
  
  
  CONCLUSIONS
  We describe two surgical approaches that allow preservation of all elements of the anal canal resulting in a normal post-operative continence and defecation.
authors.forename: M D
authors.initials: MD
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011859:Radiography; D012007:Rectum / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery