[Sacrococcygeal approach in the treatment of defects of the lower segment of the digestive tract].

The research investigations carried out for years revealed most details on embryology nd pathophysiology of anorectal malformations. They left still unsolved the problem how to obtain better functional results following their surgical treatment. It is well known, that in the group of high- supralevator deformities, the lower rectum, anal canal and internal sphincter are absent, and the terminal pouch lyes above the puborectalis sling. The purpose of the of the pull-through procedure is the reconstruction of proper relationship between bowel, the levator diaphragm and external sphincter, without damage to the muscles and pelvic plexus. The technics advocated by Stephens and Rehbein are apparently important steps forward in surgery of these defects. The sacrococcygeal route of Kraske, adapted by Stephens for operative treatment of anorectal malformations, gives approach from behind to the supralevator space for identification of puborectalis sling. The muscle is separated from urethra or vagina, and gradually the tunnel through the sling and external sphincter is created. The gentle and in proper plane pull of the bowel through an undamaged puborectalis muscle gives the possibility to save its function as rectal sphincter and receptor as well. This paper presents 76 children with anorectal malformations, treated in the Department of Pediatric Surgery during 1966 to 1975 yr. The "International" Classification, proposed in Melbourne was used to group the patients according to the level of the terminal bowel: in Supralevator , Intermediate and Translevator defects (tab. I-III). The surgical procedures in particular types of anomalies are presented in the tables IV-VII. The detailed clinical evaluation and roentgenological examination were the base to assess the type of malformation and to choose the method of treatment. To find other coincidental malformations, generally most frequently occurring in the genitourinary tract, the intravenous pyelography was the routine early investigation. Other tests, like cystography and endoscopy were done when indicted. The genitourinary tract abnormalities were found in 9 of 14 children with supralevator deformities, in 9 of 17 children with intermediate type and in 17 of 45 from the translevator group. Oesophageal atresia was present in 6 children, the congenital heart failure in 13 and skeletal malformations in 21 of the total. In neonates with supralevator anomalies the primary reconstructions were not very successful, so transversostomy became a routine preliminary procedure.(ABSTRACT TRUNCATED AT 400 WORDS)