Bowel function after surgery for anorectal malformations in patients with tethered spinal cord

Abstract

Tethered spinal cord (TC) is an anomaly frequently recognized in association with anorectal malformations (ARM). However, the influence of TC on bowel function in children with ARM remains unknown. Furthermore, there are few studies that have assessed anorectal function in children with ARM and TC. The aim of this study was to evaluate anorectal function in ARM patients with TC using clinical assessment and anorectal manometry. Among 258 patients with ARM, this retrospective investigation included 35 patients who underwent spinal magnetic resonance imaging (MRI) after surgery for ARM. The patients were divided into two groups based on the presence or absence of TC, and bowel function was assessed by Kelly's clinical score and anorectal manometry. Tethered cord was found in nine of the 35 patients (26%) with ARM. Of the ARM patients, TC was noted in four of 11 (36%) with high type anomalies, one of 8 (13%) with intermediate type anomalies, two of 14 (14%) with low type anomalies, and two of two patients (100%) with cloacal anomalies. Kelly's clinical score did not significantly differ between the two groups. However, two of the nine patients with TC had poor bowel function (Kelly's score; 2-0 points). On the contrary, patients without TC did not have poor bowel function. Anorectal manometry did not show a significant difference between patients with and without TC. However, the two patients with TC who had poor bowel function by Kelly's score had low anal resting pressure, which was essential for achieving fecal continence. In conclusion, the present study showed that tethered cord was more frequently found in patients with more severe anorectal anomalies. Patients with TC were more likely to have poor bowel function, but this did not reach statistical significance.

Prognostic evaluation of biofeedback response in patients treated for anorectal malformation

“…Correlation between spinal associated anomalies and outcome was not clear, because a poor response was reported even without these anomalies; however, if present, any patient had an excellent response. Regarding the SR, our analysis was apparently concordant with other study [26][27][28][29], because SR had high variability among similar patients and so, does not seems to be directly predictive of fecal incontinence after surgery, but it is certainly useful to predict the presence of spinal anomalies where this value is lower. Analyzing the data of patients singularly, we founded that patients with spinal anomaly have a lowest SR and they had a worse response to BFB therapy.…”

Use of anorectal manometry for evaluation of postoperative results of patients with anorectal malformation: a study from Kuwait

“…High-ARM patients had the lowest RP, with mean RP of 17 ± 7.7 and 21 ± 9.4 mm of Hg in infants and children group, respectively, thus explaining the reason for the poor clinical outcome in patients with high ARM owing to shorter sphincteric length and poor resting tone of anal canal. Similar observations of RP in ARM patients have been reported from other centers [12,15,16]. Anorectal sensory receptors reside either in rectum or in the pelvic floor.…”

Role of magnetic resonance imaging to detect occult spinal anomalies in anorectal malformations

“…17 The influence of a tethered cord on bowel dysfunction remains unknown in patients with ARM. 18 Recently, Tsuda et al 18 reported that bowel function after surgery for ARM did not differ significantly between those with or without a tethered cord. Jia et al 19 suggested that the causes of faecal incontinence may be a defect in the sacral parasympathetic nucleus innervation to the rectum during fetal development.…”