Podstawy anatomiczne leczenia operacyjnego chorób proktologicznych – budowa odbytnicy, kanału odbytu i układu mięśni zwieraczy

*Małgorzata Kołodziejczak, Iwona Sudoł-Szopińska

Streszczenie
Precise knowledge of anatomic structure of the rectum, and in particular anal canal is the basic and essential condition of correctly conducted proctological surgery.
The article discusses an anatomy of the rectum and anal canal considering practical tips which can prove useful in everyday surgical work. A particular attention was paid to an anatomy of the anal sphincters and practical implications stemming from their asymmetric arrangement, i.e. presence of puborectalis muscle on the posterior wall of the anal canal and lack of the anterior aspect of the external anal sphincter in a deep level of the anal canal. Advantages of anal endosonography with its exceptional ability to visualize anatomy of the anal canal and rectum was highlighted. Endosonographic images reflect the normal anatomy with a high precision, including sex differences in anatomy of the anterior wall of the anal canal. With satisfactory precision endosonography can define location of anal abscesses, course of anal fistulas, and visualize the range and character of anal sphincters defects. Follow-up studies are useful in differential diagnosis of recurrence of disease or in monitoring response of the sphincters to the biofeedback therapy. In the summary part some particular recommendations are offered with a view to limiting a number of therapeutic set-backs connected with surgical treatment of the most frequent pathologies of distal section of the alimentary canal, i.e. abscessess and fistulas, or incision of puborectalis muscle, or too strenuous incision of anal sphincters, or excision of mucous membrane within the transitional zone of the anal canal carrying the risk of incontinency.

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