Anatomic plane of separation between external anal sphincter and puborectalis muscle

摘要: PURPOSE: The possible existence of an anatomic and functional separation between the external sphincter puborectalis muscle has been reported in medical literature. In this article we confirm, by means clinical observations, presence such a separation, focusing on its importance understanding pathway diffusion for some suppurative anal lesions to plan advanced sphincter-sparing procedures. METHODS: Twenty adult specimens region (12 from women) were cut sagittal, coronal, paracoronal planes, stained with hematoxylin eosin, examined. pelvic floor musculature was examined three patients undergoing postanal repair operations. Thirty primary posterior posterolateral fistulas, preoperatively classified as transsphincteric (22) or suprasphincteric (8) carefully traced during after staged fistulotomy 30 (11 female) patients, their relationship evaluated. An attempt made peranally separate four (3 females) aged 56 65 years rectal cancers 4 5 cm verge so perform procedure. RESULTS: A connective plane clearly identified 14 (70 percent) specimens. (21 cases two muscles presented pronounced overlapping arrangement. anatomicofunctional easily demonstrated All fistulous tracks ran muscle, despite upward direction ones suprasphincteric. developed very low cancers. abdominoperanal rectolevatorial excision performed. coloanal anastomosis performed residual lower canal. CONCLUSION: is present sphincter. important help understand