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

Abstract

Despite surgical correction, children with anorectal malformations may experience long-term bowel dysfunction, including fecal incontinence and/or disorders of evacuation. Anorectal manometry is the most widely used test of anorectal function. Although considerable attention has been devoted to its application in the anorectal malformation cohort, there have been few attempts to consolidate the findings obtained. This systematic review aimed to (1) synthesize and evaluate the existing data regarding anorectal manometry results in children following anorectal malformation repair, and (2) evaluate the manometry protocols utilized, including equipment, assessment approach, and interpretation. We reviewed four databases (Embase, MEDLINE, the Cochrane Library, and PubMed) for relevant articles published between 1 January 1985 and 10 March 2022. Studies reporting post-operative anorectal manometry in children (<18 years) following anorectal malformation repair were evaluated for eligibility. Sixty-three studies were eligible for inclusion. Of the combined total cohort of 2155 patients, anorectal manometry results were reported for 1755 children following repair of anorectal malformations. Reduced resting pressure was consistently identified in children with anorectal malformations, particularly in those with more complex malformation types and/or fecal incontinence. Significant variability was identified in relation to manometry equipment, protocols, and interpretation. Few studies provided adequate cohort medical characteristics to facilitate interpretation of anorectal manometry findings within the context of the broader continence mechanism. This review highlights a widespread lack of standardization in the anorectal manometry procedure used to assess anorectal function in children following anorectal malformation repair. Consequently, interpretation and comparison of findings, both within and between institutions, is exceedingly challenging, if not impossible. Standardized manometry protocols, accompanied by a consistent approach to analysis, including definitions of normality and abnormality, are essential to enhance the comparability and clinical relevance of results.

Using 3D High-Definition Manometry Evaluating Anal Canal Functions in Children with Congenital Anorectal Malformations: Clinical Studies from China

“…Although anorectal manometry is now the most widely used investigational tool for detecting abnormalities in anorectal coordination and/or anal sphincter complex dysfunction, as stated in a recent systematic review on anorectal manometry in children who have undergone ARMs repair, it remains clinically challenging to determine the definitive thresholds for sphincter dysfunction that may lead to fecal incontinence [25].…”

“…According to their systematic review [25], manometric studies have been performed for the purpose of comparing different types of ARMs, evaluating operative techniques, assessing post-operative modalities, predicting bowel function, and investigating the pathophysiology and management of post-operative bowel dysfunction. Different manometric equipment, assessment protocols, and parameter definitions used in various studies have led to significant deviation in results.…”

Anorectal developmental anomalies

“…Низька кишкова непрохідність може траплятися з кількома кишковими петлями. Необхідно діагностувати аномальне співвідношення прямої кишки і сигмоподібної кишки, перехідну зонузвуження прямої кишки, нерегулярні скорочення прямої кишки та затримку контрастного матеріалу на відстрочених рентгенограмах [20]. Рентгенологічна оцінка новонародженого з неперфорованим заднім проходом включає ультразвукове досліджен-ня черевної порожнини для виявлення урологічних аномалій.…”

“…Атрезія прямої кишки є рідкісною анорактальною вадою розвитку, що поєднує нормально розвинений задній прохід і атретичний сегмент прямої кишки. Неможливість відходження меконію у новонародженого з нормальним наявним анусом повинна призвести до подальших клінічних та радіологічних досліджень, результати яких є специфічними Двадцятиденна дівчинка поступила з анамнезом хронічного блювання, відсутності меконію з народження та прогресуючого здуття живота [20]. При дослідженні промежини виявлено нормально розміщений задній прохід без нориці промежини.…”

Faecal incontinence: Retentive, non‐retentive and when to suspect organic pathology

“…The prevalence of FI in patients operated for ARM varies based on the severity and extent of the underlying congenital defect and the presence of other associated abnormalities, but the most relevant underlying pathophysiological mechanism is almost uniformly an abnormal anal sphincter function. A recent, large systematic review of the literature identified a hypotensive anal sphincter as the most consistent finding in children with ARM, particularly in those with more complex malformation types 39 . Impaired anal and rectal sensation also contribute to the FI in a subset of patients.…”