선천적 항문 직장 기형- 중위 및 고위 쇄항의 치험 2례

There are three types of anorectal malformations(ARM) according to Wingspread classification, i.e, high, intermediate and low types. Low types are more common and it can be treated via perineal approach and less invasive. But operations for intermediate and high type lesions are more technically demanding. Because the rectal pouch is located behind or above the anorectal sphincter complex and the basic pathological defect cannot be corrected via perineal approach. In 1980, de Vries and Pena did a successful operation for the high type lesion via posterior sagittal approach for anorectoplasy to radically correct the basic defect that is failure of the rectal pouch to reach anal dimple. We did two successful operations of posterior sagittal anorectoplasy on a patient with intermediate type and another patient with a high type anorectal malformation in the Department of Surgery Kosin University Gospel Hospital The high type lesion was associated with rectovaginal fistula and her first operation was transverse colostomy during her young child period probably from the wide rectovaginal fistula. Her growth and development seems to be normal with regular menstruation, though she have to manage her bowel movement with carthartics intermittently. The second patient, who had intermittent type lesion, undergone transverse colostomy at age of 13 months, followed by posterior sagital anorectoplasty 1 year later, also showed normal growth except mild constipation. Major point of the authors modification is preserving external anal sphincter muscle intact. It was not divided completely as described by de Vries and Pena, But it was pierced to accommodate the rectal pouch. KCI Citation Count: 0