Analysis of the Role of Alberto Pena in the Development and Promotion of Posterior Sagittal Anorectoplasty

Currently, posterior sagittal anorectoplasty (PSARP) is the most popular operation for anorectal malformations (ARM).t was first published in the article by deVries and Pea in 1982.Methods.The article compares the results of studies on the anatomy and pathophysiology of ARM with Pea's claims, as well as long-term outcomes after cutback procedure compared with PSARP.Results.Pea, to justify PSARP, without any evidence, began to deny the presence of an anal canal in ARM and claimed that the puborectalis muscle is not important for fecal continence.These claims were erroneous and led to the destruction of the anal canal.The use of the cutback procedure in low types of ARMs, which preserved the anal canal, leading to good long-term results in 90% of cases.After PSARP, using a similar assessment, all patients had poor results.At an international conference (2005), a classification was adopted in which there was no division into high and low types, since it was recommended to perform PSARP with all types of ARMs.This classification, adopted by Pea's invited surgeons, rated PSARP as the ideal procedure.The recommendations of the Krickenbeck classification, previously prepared by Pea, have become not only Standards for practicing physicians, but also an insurmountable obstacle to scientific research.It is necessary to revive the discussions to discuss the state of anorectal pediatric surgery.