Correlation of anorectal manometry measures to severity of fecal incontinence in patients with anorectal malformations – a cross-sectional study

Abstract

Anorectal malformations (ARM) are a spectrum of anomalies of the rectum and anal canal affecting 1 in 2500 to 5000 live births. Functional problems are common and related to the type of ARM and associated malformations. We aimed to evaluate the results of Three-dimensional High Resolution Anorectal Manometry (3D-HRAM) in long-term follow-up after surgical correction of ARM with special reference to fecal incontinence. twenty-one patients with anorectal malformations and primary repair at our center consented to participate in the study. pressures of the anal sphincter muscles and defects were addressed by 3D-HRAM. Fecal incontinence and disease-specific quality of life were evaluated by the fecal incontinence Quality of Life score and Wexner incontinence score respectively. the study was approved by the Committee in Health Research Ethics and the Danish Data Protection Agency. Median age was 22(12-31) years and 13(67%) participants were females. Sphincter defect was present in 48% (n = 10) of participants. Participants with sphincter defects had significant higher Wexner score and size of sphincter defects and mean anal squeeze pressure were correlated to Wexner score. Participants with or without sphincter defects did not differ on manometry parameters including resting anal and squeeze pressure or disease-specific quality of life. In a study of the long-term outcome after repair of anorectal malformations we found a higher Wexner incontinence score in the presence of an anal sphincter defect and the size of the defect and mean anal squeeze pressure were correlated to the Wexner incontinence score.

Video-assisted anal fistula treatment versus fistulectomy and sphincter repair in the treatment of high cryptoglandular anal fistula: a randomized clinical study

“…There was a significant improvement in Wexner score in both groups, without the predicted advantage for the VAAFT group. The presence of an anal-sphincter defect and the size of the defect along with mean squeeze pressure were previously found to correlate to faecal-incontinence score 31 , but the presence of a defect in the internal anal sphincter at follow-up in the present study did not significantly affect the results of anal manometry or faecal-incontinence score and might be explained by different study populations.…”

Comparison of Anorectal Function as Measured with High-Resolution and High-Definition Anorectal Manometry

“…This suggests that in the majority of constipated children, the 2D probe (especially with a filled rectal balloon during bear-down maneuver) may be sufficient to diagnose potential reasons for persistent symptoms of constipation, which may be the result of abnormal defecation dynamics. By contrast, the 3D catheter with its ability to detect discrete pressure gaps in the anal canal might be a better choice when dealing with patients in whom structural abnormalities are suspected (e.g., organic FI or persistent symptoms after surgery for anorectal disorders) [1, 34, 40, 41]. Whether 3D manometry might be beneficial in patients with nonretentive FI must be elucidated in larger studies as this condition was underrepresented in our sample, precluding reliable analysis.…”

Anorectal Manometry in Children

“…in patients with persistent symptoms (eg, faecal incontinence) after surgery for anorectal disorders may benefit from the usage of 3D-HR-ARM because of its ability to detect sphincter defects (26,33).…”