Tubulopapillary rectal adenocarcinoma in dog: clinical, surgical, pathological and immunophenotypical aspects: case report / Adenocarcinoma retal tubulopapilar em cão: descrição clínica, cirúrgica, anátomo-patológica e imunofenotípica: relato de caso

Intestinal carcinomas are rare in dogs. The prognosis and survival time are dependent of the histological type, the invasion of the intestinal wall by the malignant cells and the ability of primary neoplasm to produce metastasis. This study reports a case of a Yorkshire dog that developed a rectal tubulopapillary adenocarcinoma progressing to a peritoneal carcinomatosis and multiple metastasis in large intestines, bladder, kidney, iliac lymph node, liver and lungs, six months after transanal surgical resection of the primary rectal neoplasm. Clinical, surgical, pathological and immunophenotypic findings are described. COX-2 imunohistochemical score was higher in hepatic metastasis (score 9) than in the primary tumour (score 6), and the growth fraction (Ki-67) observed was of 49.2% in the rectal neoplasm.(AU)

Carcinomas intestinais são raros em cães. O prognóstico e a sobrevida são dependentes do tipo histológico, do grau de invasão nas camadas intestinais e da capacidade da neoformação primária em desenvolver metástases. Relata-se um caso de um cão, da raça Yorkshire, que desenvolveu adenocarcinoma tubulopapilar retal com evolução para carcinomatose peritoneal e múltiplos focos metastáticos no intestino grosso, na bexiga, no rim linfonodo ilíaco, no fígado e nos pulmões seis meses após ressecção cirúrgica da neoplasia primária. Aspectos clínicos, cirúrgicos, anatomopatológicos e imunofenotípicos são descritos. O escore de COX-2 na imuno-histoquímica foi maior na metástase hepática (escore 9) do que na massa primária (escore 6), e a fração de crescimento (Ki-67) na neoplasia retal foi de 49,2%.(AU)

Functional outcome of anorectal malformations and associated anomalies in era of Krickenbeck classification

Objective: To describe the management and functional outcome of anorectal malformations and associated anomalies according to Krickenbeck classification. Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2002 to December 2012

Methodology: Anorectal anomalies were classified according to Krickenbeck classification. Data was collected and proforma used regarding the primary disease associated anomalies, its management and functional outcome, according to Krickenbeck classification. Cases included were: all those children with imperforate anus managed during the study period. Qualitative variables like gender and functional outcome were reported as frequencies and percentages. Quantitative variables like age were reported as medians with interquartile ranges

Results: There were 84 children in study group. Most common associated anomaly was cardiac [38%], followed by urological anomaly [33%]. All children were treated by Posterior Sagittal Anorectoplasty [PSARP]. Fistula was present in 64 out of 84 [76%] cases. The most common fistula was rectourethral [33%], followed by recto vestibular [31%]. According to Krickenbeck classification, continence was achieved in 62% children; however 27% children were constipated, followed by 12% children having fecal soiling

Conclusion: Functional outcome of anorectal malformation depends upon severity of disease. A thorough evaluation of all infants with ARM should be done with particular focus on cardiovascular [38%] and genitourinary abnormalities [33%]

Asociación de fistula rectovaginal congénita con ano normal (Fístulas Tipo H) y atresia rectal en una paciente. Reporte de un caso y breve revisión de la literatura / Congenital recto-vaginal fistula associated with a normal anus (type H fistula) and rectal atresia in a patient. Report of a case and a brief revision of the literature.

Las malformaciones ano-rectales del tipo de fístulas recto-urogenitales congénitas con ano normal y atresia rectal son anomalías poco frecuentes. Se discute el caso de una niña con la asociación de estas dos entidades, acompañada además de una vagina doble, quien fue llevada a la consulta a los siete días de vida por la expulsión de heces a través de los genitales. Las malformaciones fueron corregidas a través de un abordaje sagital posterior, con descenso del recto hasta el ano sin disección perineal. El tabique vaginal fue resecado a través de la vulva. En la actualidad no hay evidencia de recurrencia de la fístula recto-vaginal.

Congenital recto-urogenital type fistulas with a normal anus and rectal atresia, represent both anorectal malformations that are infrequently seen in clinical practice. We describe the case of a girl with an association of these two anomalies, together with a double vagina who, on her seventh day of life, expelled feces through her genitals. The malformations were corrected by means of a posterior sagittal approach, descending from the rectum to the anus without perineal dissection. The vaginal septum was resected thru the vulva. There is no evidence of recurrence of the recto-vaginal fistula.

Is it possible folic acid reduce anorectal malformations ethylenethiourea induced in rats?

PURPOSE: To investigate the effect of folic acid (FA) in an experimental model of anorectal malformations (ARMs) ethylenethiourea (ETU) induced.METHODS:Eight female Wistar rats were divided randomly in two groups. Group A - ETU; Group B - FA+ETU; Dams from group B received daily, since two weeks before pregnancy to the end of pregnancy, FA (50mg/kg) by gavage. Dams from groups A and B, received 1% ETU (125mk/kg) by gavage on gestational day (GD) 11. Their fetuses were harvested by cesarean section on GD21 and were examined looking for ARMs. The thickness of anal stratified squamous epithelium (ASSE) and intestinal epithelium (IE) were analyzed. p<0.05*.RESULTS:One hundred and one embryos were harvested. The number of embryos; number of ARMs; mean statistical % (± SD) were determined to be, respectively: ETU - 49 [30;65% (±24%)] versus FA+ETU - 52 [1;02% (±3%)] (p=0.025). AMRs were significantly lower in FA+ETU group than in ETU group (p=0.025). The thickness (µm) of ASSE (± SD) and IE (± SD) were measured, respectively: ETU - [27.75 (±0.56) and 18.88 (±0.93)] versus FA+ETU - [28.88 (±0.61) and 21.11 (±0.16)] (p=0.001). The thickness of IE was significantly enlarged when FA was given (p=0.001).CONCLUSION:Folic acid reduces the number and enlarged the IE of ARMs ETU-induced.

Surco perineal en ginecología infantil: reporte de 2 casos clínicos / Perineal groove in pediatric gynecology: a report of 2 cases

Introduction: the perineal groove is a very uncommon anorectal anomaly. It is the result of an unknown embryology anomaly. The perineal groove is a wet sulcus extending from de fourchette to the anus. It is a benign pathology and tends to resolve spontaneously. Objective: We report two cases of girls diagnosed with perineal groove and their follow up. Cases reports: The first case is an 18 days old baby girl, that during her first clinical examination there was found a painless lineal lesion in the perineum from the fourchette to the anus, which created a big anxiety in her family. She was cared at the Pediatric Gynecology Unit, with local lubrication, doing well with the epithelization of it. The second case is an 8 year-old girl who consulted because, when being a child, she was diagnosed with a perineal lesion, but she didn't receive any special treatment and now she feels some aches in the perineum. Conclusions: The perineal groove is a benign entity pretty unknown by general practitioners or pediatricians. It is important to be up to date with this condition to avoid alarming misinterpretations.

Introducción. El surco perineal es una malformación poco frecuente, de etiología desconocida, consiste en una ranura en la línea media del periné desde la horquilla vulvar al ano, es benigna y tiende a la resolución espontánea. Objetivos: Reportar el diagnóstico y evolución de dos pacientes con surco perineal. Casos clínicos: Caso 1. Recién nacida de 18 días que previo al alta de maternidad se pesquisó una lesión lineal no dolorosa desde la horquilla vulvar al ano, lo que generó gran inquietud en su familia. En Ginecología Infantil se confirmó el diagnóstico, se manejó con lubricación del área genital evolucionando a la epitelización del surco. Caso 2. Niña de 8 años consultó por que en controles de salud se diagnosticó una "fisura" entre la horquilla vulvar y el ano que no fue tratada y presentaba molestias inespecíficas en el periné. Se indicó resección quirúrgica, pero paciente evolucionó satisfactoriamente con lubricación de la zona. Conclusiones. El surco perineal es una entidad benigna que debe ser conocida por médicos de atención ambulatoria debido a la alarma que pueden generar sus diagnósticos diferenciales.

Duplicación rectal extrofiada asociada a malformación anorrectal y transposición pene-escrotal con hipospadias perineal: Reporte de un caso clínico / Exstrophy of rectal duplication associated with anorectal malformation and penoscrotal transposition with perineal hypospadias: A case report

Se presenta el caso de un paciente masculino quien requirió tratamiento por agenesia anorrectal con fístula rectouretral y transposición pene-escrotal con hipospadias perineal, acompañados de una masa perineal. La tumoración perineal se encontró íntimamente adherida y en continuidad al recto, lo que la hace compatible con una duplicación rectal extrofiada. La reconstrucción quirúrgica de la anomalía se realizó en etapas hasta lograr resultados funcionales y estéticos aceptables.

We present the case of a male patient who required treaatment due to anorectal agenesis with recto urethral fistula and penoscrotal transposition with perineal hypospadias, associated with a perineal tumor. The perineal tumor was found strongly adhered and contiguous to the rectum which makes it compatible with an exstrophy of rectal duplication. Surgical reconstruction of the birth defect was performed in stages until acceptable biological function and esthetic results were obtained.

Anterior saggital anorectoplasty; the treatment of anorectal malformations in female children

Anorectal malformation is the common congenital malformation. Ectopic anus and vestibular fistula are Intermediate types of anorectal malformations [ARM], which are the most common in female babies. Many surgical procedures have been described for the treatment of ARM. Anterior Saggital Anorectoplasty [ASARP] is not only convenient for the anesthetist for maintenance of anesthesia but also gives better exposure of surgical structures during surgery. To determine the technical suitability and outcome of ASARP in intermediate types of ARM in female children. This Descriptive study with prospective collection of data according to a set protocol. The study was carried out at the department of Pediatric Surgery, Military Hospital, Rawalpindi, Pakistan. November 2010 to March 2014, over the period of 3 years and 5 months. The data of all female patients presenting with intermediate types of ARM and undergoing ASARP, during the study period were analyzed, with respect to age, type, associated anomalies, complications and cosmetic outcome. A total of 36 patients of intermediate variety underwent ASARP. Age ranged from 6 months to 22 years. All patients had colostomy prior to this procedure. During surgery, posterior vaginal wall tear occurred in 2 patients [5.5%]. Postoperatively, 2 patients [5.5%] had retention of urine, 2 patients [5.5%] developed wound infection with superficial disruption, anal stenosis occurred in 2 patients [5.5%] and 1 patient [2.7%] had rectal mucosa prolapse. None of them required re_ do surgery. Cosmetic outcome was excellent in 31 patients [86.1%], while it was satisfactory in 5 [13.8%] patients. Anorectoplasty through anterior approach is not only technically easy but has good cosmetic results in intermediate type of imperforate anus in female children

Acesso sagital transretal anterior (ASTRA) para vaginoplastia após complicação de anoretoplastia sagital posterior / Anterior sagittal transrectal approach (ASTRA) for vaginoplasty after complications of posterior sagittal anorectoplasty

A exposição transperineal de altas vaginas é limitada. Essas limitações podem ser contornadas usando ASTRA (anterior sagital transrectal approach). Relatamos o uso desta estratégia cirúrgica para o tratamento de um caso de atresia vaginal adquirida, após anorretoplastia posterior, em caso de malformação anorretal.

Transperineal exposure of the high portion of the vagina is limited. These limitations can be circumvented using ASTRA (anterior sagittal transrectal approach). We report the use of this surgical strategy for the treatment of a case of acquired vaginal atresia after posterior anorectoplasty due to anorectal malformation.

Diseción pélvica: Mesorecto / Pelvic disection: Mesorectum

Introdución: El mesorecto es el tejido céluloadiposoque rodea al recto y que contiene el drenaje linfático yvascular del mismo. Es más grueso por detrás y en lascaras laterales del recto. Se trata de un auténtico sacoadiposo rodeado de una fina envoltura fibrosa, la fasciavisceral de la pelvis o fascia rectal.La diseción pélvica de un cáncer de recto consta decuatro etapas: la diseción posterior del recto, la disección lateral, la diseción anterior, y la seción distal delrecto.Materiales y Métodos: Se utilzaron ocho especímenesde hemipelvis fijados con formol al 10%. Se procedió ala diseción del mesorecto identifcando el tabique recto sacro, tomando nota del segmento sacro a la alturadel cual se encontraba. Se realizaron mediciones desdeel reborde anal hasta el fondo de saco de Douglas, hastael ángulo promontorio, hasta el vértice del coxis, y hastael borde superior del elevador del ano.Resultados: La distancia promedio fue de 9,6 cm desdeel reborde anal al fondo de saco de Douglas, de 5,7 cmdesde el reborde anal hasta el coxis, de 7 cm desde elreborde anal hasta el borde superior del elevador, y de18 cm desde el reborde anal hasta el ángulo promontorio.Discusión: Al cirujano compete especialmente el conocimiento de la técnica de reseción que es por su localización, reducido espacio de trabajo, y complejidad anatómica de la región, de particular difcultad. La escisióntotal del mesorecto constiuye hoy el standard en la patología rectal neoplásica con criterio de resecabildad.El mesorecto es una vaina celulovasculonerviosaperirectal donde no es tan simple durante el procedimiento quirúrgico individualizar los elementos, máximesi el paciente es obeso, con una estructura de máximogrosor en la cara posterior, lateral y prácticamente insignifcante en la cara anterior del recto.

Introduction: The mesorectum is the celularadiposetisue suroundig the rectum that contains the vascularelements of it. It is thicker at he posterior and side facesof the rectum. This is a genuine adipose bag suroundedby a thin fibrous cap, the visceral pelvic fascia or ectalfascia. Rectal cáncer pelvic disection consists of oursteps: the posterior disection, the lateral disection, theanterior disection, and the distal section of the rectum.Materials and Methods: Eight hemipelvis specimensfixed with 10% formalin were used. The mesorectumwas disected identifying the recto sacral fascia, notingthe sacral segment of its location. Measurements weretaken from the rim of the anus to the pouch of Douglas, tothe angle promontory, to the apex of the cocyx, and tothe top edge of the levator ani.Results: The average distance was 9.6 cm from the analrim to the pouch of Douglas, 5.7 cm from the anal rim tothe cocyx, 7 cm from the anal ridge to the top of theelevator, and 18 cm from the anal angle ridge to ridge.Discusion: surgeon responsibilty especialy knowledgeof the resection technique is its location, smalworkspace, and anatomical complexity of the region,particularly dificult.Total mesorectal excision is now thestandard in neoplastic rectal pathology criteria forresection. The mesorectum is a periectalcelulovasculonerviosa sheath where it is not so simplefor the surgical procedure identifes elements, especialyif the patient is obese, with a maximum thicknes ofstructure on the back, side and face almost negligible inthe front of the rectum.

Síndrome de Currarino y enfermedad de Hirschsprung: una asociación poco frecuente / Currarino's syndrome and Hirschsprung's disease: a rare combination

The Currarino syndrome is an autosomal dominant partial sacral agenesis involving sacral vertebrae S2 to S5, with presevation of the S1 vertebrae. In the most severe form of the syndrome, the sacral agenesis is associated to presacral mass, anorrectal and urogenital malformations. Hirschsprung's disease is a congenital malformation of the hindgut determined by the absence if parasympathetic intrinsic ganglion cells in the submucosal and myenteric plexuses. We present a case of a 3 years old male child affected from Currarino syndrome associated to Hirschprung's disease.

El Síndrome de Currarino consiste en agenesia sacra parcial de herencia genética autosómica dominante parcial, que afecta las vértebras sacras S2 a S5, preservándose S1. En la forma más severa del síndrome, a la agenesia sacra se asocian masa presacra y malformaciones anorrectales y urogenitales. La enfermedad de Hirschsprung es una malformación congénita del intestino grueso debida a la ausencia de células ganglionares intrínsecas parasimpáticas de la submucosa y de los plexos mientéricos. Presentamos el caso de un niño de 3 años con Síndrome de Currarino asociado a enfermedad de Hirschsprung.

Anomalia anorretal e cuidados maternos / Anorectal anomaly and maternal care / Anormalidades anorectales y la atención materna

O objetivo deste artigo foi realizar um estudo de revisão bibliográfica sobre anomalia anorretal e cuidados maternos. O assunto foi abordado por meio de revisão integrativa realizada em consulta de artigos publicados nas bases de dados indexados na Biblioteca Virtual em Saúde. Foram identificadas 25 publicações que atenderam aos critérios de inclusão e exclusão pré-estabelecidos. Nos estudos analisados observaram-se distintos desenhos metodológicos demonstrando que algumas crianças nascidas com anomalia anorretal necessitam de cirurgia de urgência. Os profissionais de saúde, juntamente aos pais, precisam desenvolver parcerias que possibilitem um acompanhamento a longo prazo e orientações cuidadosas. Faz-se necessário que novas pesquisas sejam realizadas sobre o tema, com propostas metodológicas que retratem melhor a essência do cuidado com as crianças estomizadas.

This purpose of the article was to make a bibliographic review about anorectal malformations and maternal cares. The matter was addressed through an integrative review undertaken in consultation of articles published in the databases indexed in the Virtual Health Library. We identified 25 publications that met the inclusion and exclusion criteria pre-established. In the studies reviewed, there were different study designs, demonstrating that some children born with anorectal anomalies requiring urgent surgery. Health professionals, along with the parents, need to develop partnerships that would enable a long-term monitoring and careful guidance. It is necessary to do more research on the subject, with methodological proposals that reflect the essence of the best care of an ostomized child.

El objetivo de este artículo fue realizar un estudio de revisión bibliográfica sobre anomalía ano retal y cuidados maternos. El asunto fue abordado por medio de una revisión integral realizada por consulta de artículos publicados en las bases de datos indexados en la Biblioteca Virtual en Salud. Fueron identificadas 25 publicaciones que atendieron a los criterios de inclusión y exclusión pre-establecidos. En los estudios analizados se observaron distintos dibujos metodológicos demostrando que algunos niños nacidos con anomalía ano retal necesitan de cirugía de urgencia. Los profesionales de salud, juntamente con los padres, necesitan desarrollar grupos que posibiliten un acompañamiento a largo plazo y orientaciones cuidadosas. Se hace necesario que nuevos estudios sean realizados sobre el tema, con propuestas metodológicas que retraten mejor la esencia del cuidado con los niños con ostomía.

Spontaneous bowel perforation in a neonate with anorectal malformation

Gastrointestinal perforation in neonates with anorectal malformations is extremely uncommon. Delayed patient presentation is an important factor that demands special attention. We present a neonate with anorectal malformation and meconium peritonitis following spontaneous bowel perforation. A day 1 neonate was referred with features suggested of peritonitis. After adequate resuscitation and drainage under local anesthesia, patient was successfully operated for a sigmoid perforation and is now awaiting definitive surgery for the anorectal malformation

Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria

Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5) and 106 (65.8) emergency operations in groups A and B; respectively. There were 61 (45.5) and 55 (34.2) elective operations in groups A and B; respectively. Regarding treatment; in group A; patients requiring colostomy had transverse loop colostomy; while in group B; sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5); anal transplant 5 (8.2); sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5) and others 21 (34.4). In group B; posterior sagittal anorectoplasty (PSARP) 46 (83.7); anal transplant 1 (1.8); posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6) and anal dilatation 6 (10.9) were done. Early colostomy-related complication rates were similar in the two groups (P 0.05). The overall late complication rate was 65.5in group A and 16.4in group B (P 0.05). The mortality was 25 (18.6) in group A compared to 17 (10.6) in group B (P 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades; resulting in improved outcomes

Hamartoma quístico retrorrectal: presentación de un caso pediátrico / Retrorectal cyst hamartom: report of a pediatric case

El hamartoma quístico retrorrectal o quiste retrorrectal es una lesión benigna infrecuente de origen malformativo. Presentamos el caso de una niña de 7 días con un tumor retrorrectaldiagnosticado por ecografía durante el embarazo. En el examen histológico se observó un quiste revestido por epitelioescamoso y urotelial típicos, y una doble capa de músculo liso. El tratamiento de elección es la resección completa de lalesión, ya que se han observado recurrencias locales o transformaciónmaligna.

Diphallus with imperforate anus and complete duplication of recto-sigmoid colon and lower urinary tract

Diphallus is a rare anomaly and accompanying anomalies vary from bifid scrotum, bladder exstrophy, imperforate anus and colo-rectal anomaly such as duplication, and | other associated anomalies. A 2-day old infant is reported with imperforate anus and complete duplication of recto-sigmoid colon, rectal pouch, doubling of the genitalia with completely formed penis [diphallus], double bladder, urethra and hypospadias. No family history of abnormalities was noted. The patient underwent several operations: laparatory and colostomy at 3rd day of life, and after clinical and paraclinical investigations, cystoplasty, ureteral reimplantation and resection of left phallus were carried out when 4 months old. At the age of 1 year, after colostogram and total colon evaluation, laparatomy, resection of duplicated recto-sigmoid colon, and pull-through was carried out; 3 months later colostomy closure was performed and the patient discharged without complications. The patients with diphallus have to be examined carefully because of the high incidence of other systemic anomalies. Treatment of diphallus usually includes excision of the duplicated penile structure, its urethra, and repair of associated anomalies

Prenatally Detected Congenital Perineal Mass Using 3D Ultrasound which was Diagnosed as Lipoblastoma Combined with Anorectal Malformation: Case Report

We report a case of prenatally diagnosed congenital perineal mass which was combined with anorectal malformation. The mass was successfully treated with posterior sagittal anorectoplasty postnatally. On ultrasound examination at a gestational age of 23 weeks the fetal perineal mass were found on the right side. Any other defects were not visible on ultrasonography during whole gestation. Amniocentesis was performed to evaluate the fetal karyotyping and acetylcholinesterase which were also normal. As the fetus grew up, the mass size was slowly increased more and more. At birth, a female neonate had a perineal mass on the right side as expected. During operation, the anal sphincteric displacement was found near the mass and reconstructed through posterior sagittal incision. This is the first reported case of prenatally diagnosed congenital perineal mass, after birth which was diagnosed as lipoblastoma and even combined with anorectal malformation. This case shows that it can be of clinical importance to be aware of this rare fetal perineal mass in prenatal diagnosis and counseling.

Esfínter artificial para la reconstrucción anorrectal total: reporte preliminar y revisión de técnica quirúrgica / Artificial bowel sphincter for anorectal reconstruction: preliminary report and review of surgical technique

Introduction: The artificial sphincter (ABS) has been proposed as an option for the treatment for severe refractory fecal incontinence. We have witnessed a great discussion on systematic reviews regarding the short-and long-term results of ABS, assessing its real benefit. Objective: To analyze the surgical outcomes of patients undergoing artificial sphincter implantation and review of surgical technique. Material and Methods: Between 2003 and 2007, the ABS system was introduced in four patients. The mean age was 34 years (13 to 54 years). Two patients were admitted for rectal agenesis, a severe anorectal trauma and abdominoperineal resection for a low rectal cancer. Results: Follow-up time was 12 to 60 months. We performed the explantation of the device for perineal wound infection in one case. All patients had mild incontinence ABS showed a decrease an average of 3.5 points to 12 months of follow-up on the Wexner Scale. Conclusions: The installation of the artificial sphincter is a feasible and safe alternative for anorectal reconstruction in selected patients. The morbidity and explantation of the series is similar to other international reports.

Introducción: El esfínter artificial (siglas en inglés ABS) ha sido propuesto como una opción para el tratamiento de incontinencia fecal severa refractaria. Hemos sido testigos de una gran discusión en revisiones sistemáticas respecto a los resultados a corto y largo plazo del ABS, evaluando su real beneficio. Objetivos: Analizar los resultados quirúrgicos de los pacientes sometidos a implante de esfínter artificial y revisar la técnica quirúrgica. Material y Métodos: Entre los años 2003 y 2007 se implantó el sistema ABS en cuatro pacientes. La edad media fue de 34 años (13 a 54 años). Dos pacientes ingresaron por agenesia rectal, uno por trauma anorrectal severo y otro por resección abdominoperineal de un cáncer de recto bajo. Resultados: El tiempo de seguimiento fue de 12 a 60 meses. Se realizó la explantación del dispositivo por infección de herida perineal en un caso. Todos los pacientes que mantuvieron el ABS presentaron incontinencia leve con un descenso a los 12 meses de seguimiento a una media de 3,5 puntos en la escala de Wexner. Conclusiones: La instalación del esfínter artificial es una alternativa segura y realizable para la reconstrucción anorrectal en pacientes seleccionados. El porcentaje de morbilidad y explantación de la serie es similar a otros reportes internacionales.

Scenario of neonatal surgery in West Bengal with refrence to cases of anorectal malformation.

Pediatric Surgery, though a super specialty does not enjoy the glamour and importance like other specialities, though, dealing with the most delicate of mankind, the children. The reasons for this are manifold and the results of this, brutal. This is a retrospective study carried at the major institutes of West Bengal where departments of pediatric surgery exist. We have observed a gross discrepancy between the number of patients admitted for surgically correctable congenital malformations and the standard state/ national frequency of these disorders. We focus on the plight of a child not able to reach the leval III health care system with a pediatric surgical back up and analyze the pros and cons with constructive criticism of the existing system.