Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations

Abstract

Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations Federal University of Siio Paulo -PSM -Siio Paulo, BrazilPSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence: From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARp' due to the existence of a relationship between the manometric results and the degree of fecal continence.

Post-Operative Anorectal Manometry in Children following Anorectal Malformation Repair: A Systematic Review

“…Studies utilized anorectal manometry to evaluate a range of aspects relating to the management of anorectal malformation patients. Anorectal manometry was performed to compare malformation types [ 14 , 15 , 16 , 17 , 18 , 19 ]; appraise operative techniques [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]; evaluate post-operative assessment modalities [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]; assess and/or prognosticate bowel function [ 45 , 56 , 57 , 58 , 59 , 60 ]; and investigate the pathophysiology [ 46 , 61 , 62 , 63 , 64 ] and management [ ...…”

“…Fluid-perfused (water, saline or not described) catheters were used by the majority. Other reported methods included balloon or microballoon [ 16 , 37 , 49 , 50 , 69 ], solid-state [ 25 ], and microtransducer [ 40 , 45 , 64 ]. High-resolution manometry was utilized in six studies [ 22 , 34 , 52 , 54 , 64 , 72 ].…”

“…A range of sedation strategies were reported, including chloral hydrate, ketamine, and nitrous oxide [ 26 , 28 , 29 , 30 , 31 , 34 , 35 , 38 , 39 , 47 , 48 , 49 , 54 , 57 , 63 , 69 , 73 ]. Anorectal manometry was performed without sedation in nine studies [ 14 , 22 , 32 , 43 , 50 , 52 , 55 , 57 , 67 ]. Reported approaches to preparation and sedation are summarized in Table 2 .…”

“…In addition to assessment of the anorectum, one study also included assessment of the rectosigmoid region (resting pressure recorded 20, 15, 10, and 5 cm proximal to the anal verge) [ 62 ]. Six studies did not define the location of assessment [ 23 , 25 , 42 , 50 , 53 , 64 , 76 ].…”

Assessment of postoperative results in anorectal malformations

“…[25] Other studies using anorectal manometry have also shown the objective utility in assessing postoperative results. [26,27] Anorectal manometry can also demonstrate objective evidence of improvement with biofeedback therapy. In these patients, the prerequisites are that the sphincter should not be hypoplastic, and the bowel should not be misplaced.…”