wetenschapsdag 2023 | 77 Sessie 2d: Laparos: het Ontwerp Binnenste Binnen Keren x1 Auteurs D. Docter B.S. de Bakker L.W.E. van Heurn R.R. Gorter Abstract titel Studying surgical anatomy of Anorectal malformations through micro-CT imaging Background Anorectal malformations (ARM) constitute a spectrum of congenital disorders impacting the anal-rectal complex, leading to defecation difficulties. The advent of the Anterior/Posterior Sagittal Anorectoplasty (A/PSARP) surgical procedure marked significant progress in ARM management. Nevertheless, three decades later, patients still suffer from high rates of incontinence and obstipation. The precise functional anatomy and embryology of this complex area remain topics of debate. Our study employs micro-CT imaging, a revolutionary non-destructive X-ray-based technique capable of ultra-high-resolution 3D imaging, to provide new insights into ARM morphology, with the aim of refining surgical techniques. Methods Twelve ARM patients underwent A/PSARP and surgically excised fistulae were collected. As healthy controls, we utilized three fetal pelvises from the Dutch Fetal Biobank. All samples were fixed using 4% paraformaldehyde (PFA) and stained with 3.75% B-Lugol for 48 hours. Scan acquisition was performed using the GE Phoenix Nanotom M tomographer (Waygate Technologies, Wunstorf, Germany). Scans had a voxel size ranging from 4-6 micrometers and were 3D reconstructed using Amira Software. After four weeks of destaining in 0.2% PFA, we conducted histology using Hematoxylin and Eosin staining to validate scan results. Results All specimens exhibited normal rectal wall development similar to fetal samples. The mucosa contained crypts with goblet cells, resembling simple columnar epithelium. Distally, it transitioned to stratified squamous epithelium. Muscle fibers, arranged circularly in the sample wall, indicated a developed intrinsic sphincter. Histological examination confirmed these findings and revealed innervation of the muscle. Conclusion Micro-CT is a promising technique for researching surgical anatomy by providing microscale resolution 3D imagery in a nondestructive fashion. Our findings suggest that the resected fistula during A/PSARP may contain vital elements for continence and normal defecation. This challenges current surgical practices for ARM and calls for a reconsideration of techniques to preserve these structures, potentially improving patient outcomes in the process.
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