Why I'm here?
I'm Dr. Levin Michael. I dedicated my lifetime research to the anal malformations and other gastro-intestinal defects, created this unique methods and conducted more that hundreds procedures.
Radiological, histological, and other multidisciplinary studies of patients with anorectal malformations are carried out in the Belarusian center of pediatric surgery, which is located in Minsk, the capital of Belarus, during the last 35 years. These studies showed that the final section of the digestive tract in the majority of anorectal malformations is a normally functioning anal canal, though it was formerly considered to be a fistula or rectal pouch. In fact, it is surrounded by muscles that provide the normal fecal continence and defecation.
Advanced treatment of anorectal malformations
It differs from the normal anal canal just that it opens by a narrow opening on the perineum or vagina in girls and at the perineum, or urinary tract in boys. This discovery had a strong impact on the treatment strategy.
The use of surgical interventions without saving all the elements of the anal canal leads to the development of chronic constipation or fecal incontinence. Pediatric surgeons consider such results as good, claiming that the results cannot be normal, since in the anorectal malformations the anal canal is supposedly absent. We have developed simple surgical techniques that preserve all the muscles involved in the fecal continence and defecation, and save the neural connections that are essential for the normal function of the rectum and sexual life of patients. Long-term results of operations, performed in the first year of life, don’t differ from the physiological norm.
Anorectal malformations //
Any science including medicine, develops as a result of new ideas which suggest new solutions based on known scientific facts. These hypotheses contain assumptions, which are not contrary to the known laws. Only in cases where after multiple testing of the hypothesis the hypothetical assumptions proved correct, the hypothesis turns into a theory. In order to solve one problem, several hypotheses may be proposed. Scientific development is a struggle of hypotheses. If an indisputable scientific fact contradicts the hypothesis, a hypothesis must be edited or eliminated from the struggle. From the middle of the last century, medicine has undergone great changes that have dramatically worsened the scientific climate: the blurring of the boundaries between the concepts of hypothesis and theory, the neglect of scientific evidence, the fascination with new technical methods of research where the direction of researches is dictated by the rich companies producing these technologies.
Example: In the middle of the last century it was considered that at low anorectal malformation (ARM) there is anal canal caudal to the pubococygeal line, and it must be used at the correction of the anomaly. Since the end of the last century in the works of A.Peña and M.A.Levitt there appeared a notion that anal canal is absent in ARM with an exception of rectal atresia, and the so-called rectal pouch has no sensitivity and have no use for the correction of ARM. It was concluded that posterior sagittal approach is the best method of surgical intervention. At the same time, chronic constipation, fecal incontinence and other postoperative complications are attributed to the lack of the anal canal. The outcomes of posterior surgical approach were declared as remarkable, and in support of this opinion the new classification was established according to which poor outcomes (constipation and encopresis) now are considered as "good". On one hand, this hypothesis is still considered dominant in contemporary medical community despite the fact that the authors did not show any evidence for the absence of the anal canal. On the other hand, when the published works by other authors proved the presence of rectoanal inhibitory reflex with normal sensitivity of the "fistulous" wall in most patients with ARM, and when there was evidence from histologists that this defect is in fact an ectopic anus as well as evidence from surgeons that the use of so-called fistula improves the functional results, no response from the scientific community followed. Thus, two mutually exclusive hypotheses currently exist side by side in the literature and it is nonsense.
I invite you to discuss the hypotheses of normal physiology of the digestive tract and urinary system, as well as the pathogenesis of some diseases. Your comments can be sent to firstname.lastname@example.org. They will be published on this website. I will be very grateful to those visitors who would agree to edit my English.
What You Need to Know
Before Choosing a Surgeon
- Knowing the right questions to ask
- When is the right time to have surgery
- Exploring non-invasive alternatives