Introduction

Anorectal malformations (ARM) represent a wide spectrum of defects. The terms low, intermediate, and high are arbitrary and not very useful in therapeutic or prognostic terms. Within the group of ARM traditionally referred to as high, there are defects with different therapeutic and prognostic implications. For instance, retroprostatic fistula and rectobladderneck fistula were both considered high, yet the first can be repaired with a posterior sagittal approach alone, but the second also requires an abdominal approach. The prognosis for each type is completely different. Therefore, anatomic descriptions of the malformations are more useful clinically (Table 20.1).

In the past, many surgical techniques to repair ARM have been described. These included endorectal dissection [1-3], anterior perineal approach to a rec-tourethral fistula [4], and many different types of ano-plasties [5]. However, most pediatric surgeons now use the posterior sagittal approach to repair these malformations with or without laparotomy or lapa-roscopy. The debate recently has been centered more on the possibility of performing these operations primarily without a protective colostomy and using lapa-roscopy if an abdominal component is needed [6-8].

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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