Surgical treatment of colovaginal fistula associated with pelvic megacolon and anorectal aplasia and its result after 10 years (dedikált példány) [antikvár]

SURGICAL TREATMENT OF COLOVAGINAL FISTULA ASSOCIATED WITH PELVIC MEGACOLON AND ANORECTAL APLASIA AND ITS RESULT AFTER 10 YEARS F. Oberna, P. Bacs and J. Dbvai budapest, hungary 1 In medical literature opinions differ as to the frequency of anomalous development of the anorectum. According to Pilaszanovich (1964) and collaborators, Viszt (1961) and Drexler (1958) 1 anorectal anomaly was found in 1500 cases, to others (Kovacs 1941) 1 in 16,000 cases, while again others report on 1 in 25,000 cases of newborns. Their classification is also ambiguous. The best known classifications are those of Ladd (1934), Gross (1954) and Gough (1961). A disturbing fact is, however, that the majority of authors use individual nomenclatures. It is desirable that a uniform classification and nomenclature be realized by a competent committee when phylogenetic, anatomical and surgical viewpoints should also be taken into consideration. The treatment of anorectal anomalies is surgical. In group I of Gross (1954) this consists of dilating or eventually cutting off the stenosis when turning out and sewing the mucous membrane onto the skin. In group II a cross-like incision of the anus membranaceus imperforatus with simultaneous turning out and sewing is made on the mucous membrane onto the skin. In group III in case the anus is missing but the pars ampullaris of the rectum is developed and ends blindly and low, at the level of the coccyx, or — forming a fistula beneath the hymen — the anomaly may be healed by means of perineal proctoplasty described by Dieffenbach and Rizzioli and modified by Potts et al. (1954). In connection with this procedure the sphincter ring on the perineum must be prepared and dilated, and the perineally freed rectal end, pulled into the levator tube and sphincter ring, must be spread over the perineum. In the meanwhile the fistula should be prepared and cut across, between the ligaments. In group IV of Gross (1954) in case the blind pouch of the rectum is separated by a thin membrane from the developed anus, this particular membrane may be opened from the direction of the anus. Should a fistula lead, in any of the cases of Gross, into the vagina, then the only possible solution would be an abdominoperineal operation. The same is true in groups III and/or IV for cases of agenesis, rectal aplasia, with the colon ending blindly at the peritoneal reflection, at the second sacral vertebra, or even at a higher level, or ending through a fistula into the bladder, the urethra, or the vagina. In respect of the latter cases the idea of an abdominoperineal operation was suggested in Hungary by Alapy as far back as 1914 while the descrip- 6 81