{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T21:42:21Z","timestamp":1776807741259,"version":"3.51.2"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003This study aims to assess the histopathological characteristics of the fistulous tissue in males with anorectal malformation (ARM) to determine its suitability for use in constructing a neoanus.<\/jats:p><jats:p>\n          Methods\u2003This prospective observational study included male ARM patients with recto-urethral fistula. All other types were excluded. The tissue specimens comprised 0.5 to 2.0\u2009cm of the most distal part of the rectal pouch and the fistulous tissue. Hematoxylin and eosin-stained sections were prepared. Histological features, viz. internal sphincter, anal grand and crypts, ganglion cells, presence of subepithelial fibrosis, thickened nerve trunks, and metaplasia, were evaluated.<\/jats:p><jats:p>\n          Results\u2003Of 65 patients of ARM admitted, 24 met the inclusion criteria. Gross and microscopic internal sphincter was not found in any sample. The anal mucosa was visualized in all samples; however, crypts were irregular and distorted architecture was seen in 4 (16.67%) samples. Urothelial metaplasia was identified in 10 (41.67%) samples. Adequate ganglion cells were seen only in 6 (25%) samples. Significant submucosal fibrosis was seen in all samples. Thickened nerve trunks were identified in 4 (16.67%) samples.<\/jats:p><jats:p>\n          Conclusions\u2003All normal anal histological features could not be found together in the fistula tissue. With the absence of normal features, such as internal anal sphincter muscles, and the presence of abnormal histopathological features, such as subepithelial fibrosis, thickened nerve trunks, and metaplasia, there are high chances of abnormal bowel function like constipation if the fistulous tissue is used for neoanus construction. It may have an impact on the quality of life of patients.<\/jats:p>","DOI":"10.1055\/a-2389-7550","type":"journal-article","created":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T23:43:25Z","timestamp":1723851805000},"page":"015-021","source":"Crossref","is-referenced-by-count":2,"title":["Rethinking Fistula Preservation in Anorectal Malformation Surgery: A Histopathological Perspective"],"prefix":"10.1055","volume":"35","author":[{"given":"Preeti","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shubhajeet","family":"Roy","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3514-0225","authenticated-orcid":false,"given":"Anand","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nirpex","family":"Tyagi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitin","family":"Pant","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piyush","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiledar","family":"Rawat","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,9,9]]},"reference":[{"key":"ref1","first-page":"163","volume-title":"incidence and frequency of different types, and classification of anorectal malformations","author":"F Murphy","year":"2006"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/0022-3468(90)90358-G","article-title":"The rectourogenital connection in anorectal malformations is an ectopic anal canal","volume":"25","author":"R Rintala","year":"1990","journal-title":"J Pediatr Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/BF00176069","article-title":"Internal anal sphincter function after correction of imperforate anus","volume":"6","author":"B Frenckner","year":"1991","journal-title":"Pediatr Surg Int"},{"issue":"01","key":"ref4","first-page":"41","article-title":"Epithelium and anal glands in rectal pouches and fistula. Histologic studies of swine with congenital anal atresia [in German]","volume":"44","author":"W Lambrecht","year":"1989","journal-title":"Z Kinderchir"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s00383-020-04786-x","article-title":"Epithelial and ganglionic distribution at the distal rectal end in anorectal malformations: could it play a role in anastomotic adaptation?","volume":"37","author":"K Uemura","year":"2021","journal-title":"Pediatr Surg Int"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S1015-9584(08)60089-5","article-title":"Histology of the terminal end of the distal rectal pouch and fistula region in anorectal malformations","volume":"31","author":"A N Gangopadhyay","year":"2008","journal-title":"Asian J Surg"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1055\/s-2008-1066122","article-title":"Results in the treatment of anorectal malformations with special regard to the histology of the rectal pouch","volume":"4","author":"A M Holschneider","year":"1994","journal-title":"Eur J Pediatr Surg"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/S0022-3468(96)90738-1","article-title":"Innervation patterns of the rectal pouch and fistula in anorectal malformations: a preliminary report","volume":"31","author":"A M Holschneider","year":"1996","journal-title":"J Pediatr Surg"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1177\/10935266211049689","article-title":"Submucosal nerve diameter in the rectum increases with age: an important consideration for the diagnosis of hirschsprung disease","volume":"25","author":"M R Conces","year":"2022","journal-title":"Pediatr Dev Pathol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"X19829263","DOI":"10.1177\/2632010X19829263","article-title":"a pilot study on histopathology of the jejunoileal atresia-can it be used as a guide to determine the length of adequate resection?","volume":"12","author":"A Pandey","year":"2019","journal-title":"Clin Pathol"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1007\/BF01648833","article-title":"Internal sphincter-saving in imperforate anus with or without fistula. A manometric study","volume":"1","author":"F Penninckx","year":"1986","journal-title":"Int J Colorectal Dis"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/DCR.0b013e31826e4a38","article-title":"Pre- and postoperative rectal manometric assessment of patients with anorectal malformations: should we preserve the fistula?","volume":"56","author":"E M Ruttenstock","year":"2013","journal-title":"Dis Colon Rectum"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s003830050002","article-title":"Histopathologic observations of anorectal abnormalities in anal atresia","volume":"16","author":"W A Meier-Ruge","year":"2000","journal-title":"Pediatr Surg Int"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/jpc.13691","article-title":"Histology with immunohistochemistry of the fistula region in female anorectal malformation: can it be used for neo-anus reconstruction?","volume":"54","author":"A Pandey","year":"2018","journal-title":"J Paediatr Child Health"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1124647","DOI":"10.3389\/fped.2023.1124647","article-title":"Significance of searching for ganglia in the terminal rectum\/fistula of complex anorectal malformations: Related to defecation function","volume":"11","author":"W Feng","year":"2023","journal-title":"Front Pediatr"},{"issue":"06","key":"ref16","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1016\/j.jpedsurg.2013.03.026","article-title":"Abnormalities in \u201clow\u201d anorectal malformations (ARMs) and functional results resecting the distal 3\u2009cm","volume":"48","author":"L Lombardi","year":"2013","journal-title":"J Pediatr Surg"},{"issue":"31","key":"ref17","doi-asserted-by":"crossref","first-page":"e11675","DOI":"10.1097\/MD.0000000000011675","article-title":"Histopathologic and immunohistochemical findings in congenital anorectal malformations","volume":"97","author":"H Xiao","year":"2018","journal-title":"Medicine (Baltimore)"},{"issue":"12","key":"ref18","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S0022-3468(87)80728-5","article-title":"The internal sphincter in anorectal malformations: morphologic investigations in neonatal pigs","volume":"22","author":"W Lambrecht","year":"1987","journal-title":"J Pediatr Surg"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.jpedsurg.2015.09.003","article-title":"Assessment and comparison of fecal continence in children following primary posterior sagittal anorectoplasty and abdominoperineal pull through for anorectal anomaly using clinical scoring and MRI","volume":"51","author":"A N Gangopadhyay","year":"2016","journal-title":"J Pediatr Surg"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"102203","DOI":"10.1016\/j.epsc.2022.102203","article-title":"Anorectal malformation and Hirschsprung disease in an otherwise healthy infant","volume":"78","author":"A Rougraff","year":"2022","journal-title":"J Pediatr Surg Case Rep"}],"container-title":["European Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2389-7550.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T23:49:40Z","timestamp":1737762580000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2389-7550"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,16]]},"references-count":20,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2025,1,24]]},"published-print":{"date-parts":[[2025,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2389-7550","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0939-7248","1439-359X"],"issn-type":[{"value":"0939-7248","type":"print"},{"value":"1439-359X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,8,16]]},"published":{"date-parts":[[2024,8,16]]}}}