AI Article Synopsis
- The study focused on analyzing the epithelial and ganglionic structures of the distal rectal end in patients with anorectal malformations (ARMs) during surgical treatment.
- A retrospective analysis of 60 ARM patients revealed that the epithelial type and arrangement in ARMs closely resembled those found in a normal anal canal, with a high prevalence of stratified columnar epithelium.
- The findings suggest that preserving the anal transitional zone during surgery could help create a more accurate reconstruction of the anal canal structure in ARM patients.
Article Abstract
Purpose: In anorectal malformations (ARMs), the epithelium of the distal rectal end is not well described. We histomorphologically evaluated epithelial and ganglionic distribution in the distal rectal end of ARMs resected during anorectoplasty to assess similarities and differences with normal anal canal structure.
Methods: In this single-center retrospective study, specimens from 60 ARM patients (27 males, 33 females) treated between 2008 and 2019 were evaluated.
Results: Epithelium type and alignment sequence as well as ganglionic distribution were similar in the distal rectal end and in a normal anal canal. Stratified columnar epithelium (anal transitional zone, ATZ) was seen in 49/60 (81.7%) cases and in all ARM types, including the no-fistula type. Anal crypts were identified in the stratified columnar epithelium (ATZ) of 46/49 (93.9%) patients. Regarding distal rectal end-resecting anorectoplasty, in 90% of patients, resection was performed distal to the Herrmann line. Ganglion cell distribution was exclusively proximal to the Herrmann line.
Conclusion: Epithelial and ganglionic distribution was similar in the distal rectal end of ARMs and in a normal anal canal. The ATZ is the epithelial boundary between the rectum and skin in a normal anal canal. ATZ preservation could reproduce anal canal structure in ARM reconstruction.
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