How to Preserve the Anal Canal in Patients with Anorectal Malformations

¹Department of Pediatric Radiology of the 1-st State Hospital, Minsk, Belarus, Dorot. Medical Center for Rehabilitation and Geriatrics, Amnon veTamar, Netanya, Israel

*Corresponding Author: Dr. Michael Levin, Department of Pediatric Radiology of the 1-st State Hospital, Minsk, Belarus, Dorot. Medical Center for Rehabilitation and Geriatrics, Amnon veTamar, Netanya, Israel, Tel: 972-538281393, E-mails: [email protected]; [email protected]

Received Date: September 09, 2026

Published Date: November 02, 2026

Citation: Levin MD. (2026). How to Preserve the Anal Canal in Patients with Anorectal Malformations Mathews J Gastroenterol Hepatol. 11(2):44.

Copyrights: Levin MD, © (2026).

ABSTRACT

Background: The surgical management of anorectal malformations (ARMs) remains largely based on the concept that the anal canal is absent or nonfunctional in many affected patients. This assumption underlies the widespread use of posterior sagittal anorectoplasty (PSARP), which may sacrifice existing anatomical structures essential for normal anorectal function.

Objective: To present an alternative interpretation of the pathological anatomy and physiology of ARMs and propose surgical strategies aimed at preserving the anal canal and its function.

Methods: This article analyzes embryological principles, radiographic findings, histological observations, anorectal manometry, published clinical outcomes, and the author’s clinical experience. Different forms of imperforate anus are examined, including malformations with visible perineal or vestibular openings, urethral ectopy, congenital anal stenosis, and vaginal ectopy traditionally classified as persistent cloaca.

Results: The analysis supports the hypothesis that a normally formed, potentially functional anal canal is present in most forms of imperforate anus, although its external opening may be ectopic, stenotic, or absent. Radiographic observations demonstrate that the anal canal can open in response to increased rectal pressure, while histological and manometric findings provide additional evidence of its presence and function. These findings challenge the assumption that conventional pull-through procedures are necessary for all ARMs. For malformations with visible ectopic openings, a modified cutback procedure may preserve the anal canal. For selected malformations without visible openings, perineal perforation or delayed reconstruction using endoscopic guidance through a colostomy may offer alternative approaches. The article also questions the classification of certain vaginal ectopias as persistent cloaca and challenges the assumption that extensive urogenital reconstruction is always necessary.

Conclusions: The preservation of existing anatomical structures and physiological function should be a central principle in ARM surgery. The proposed approach challenges established surgical paradigms and calls for systematic clinical evaluation of anatomy-preserving procedures, with particular attention to long-term fecal continence, bowel function, and urinary function. Prospective studies with adequate follow-up are needed to establish the comparative safety and effectiveness of these approaches.

Keywords: Anorectal Malformations, Anal Canal Ectopy, Cutback Procedure, Perineal Perforation Procedure, Posterior Sagittal Anorectoplasty, Persistent Cloaca