Functional Co-Relation Between Operated Cases of Anorectal Malformation and Post-Operative Pelvic Mri

Abstract

BACKGROUND The treatment of ARM has evolved from a simple cutback/translocation anoplasty to abdominoperineal pull through, its modification, to the currently practiced procedure of posterior sagittal anorectoplasty (PSARP). We wanted to evaluate the relation of the type of anorectal malformation with surgical procedure done, and also the functional outcome with post-operative pelvic MRI. METHODS A cross sectional study was undertaken at the Department of Paediatric Surgery, a tertiary care hospital from October 2013 to September 2015. Children suffering from ARM who have completed all stages of surgery with regular follow up who are at least 3 years old and still having having bowel dysfunction were included in the study. RESULTS Twenty-one patients were included in this study; sex ratio was 3.2:1 (M:F). 16 male patients having high and intermediate ARM underwent PSARP or Abdomino-Perineal pull through procedure. 5 female patients having (Anovestibular/ rectovestibular/anteriorly placed anus) underwent Anterior Sagittal Anorectoplasty (ASARP) procedure. Out of 21 patients, 9 had poor voluntary bowel movement (42.87%), 7 had constipation (33.3%) and 5 patients presented with soiling (23.80%). Abnormal local finding on pelvic MRI was seen in 16 patients (76.19%) in the form of misplaced neorectum, hypoplastic muscle complex, perianal fat or abnormal anorectal angle and 7 patients had bony abnormalities or cord anomalies. CONCLUSIONS MRI is a useful modality in operated children of ARM with poor outcomes of continence. Local abnormalities are more common in children under going abdomino-perineal pull through than PSARP.