Posterior sagittal anorectoplasty in anorectal anomalies: clinical, manometric and profilometric evaluation

Abstract

CONTEXT AND OBJECTIVE: Anorectal malformations comprise a spectrum of anomalies that continue to be difficult to treat, even today. The aim was to evaluate the fecal continence of children who underwent posterior sagittal anorectoplasty due to anorectal malformations, via computerized anorectal manometry and profilometry. DESIGN AND SETTING:Prospective study at Universidade Federal de São Paulo.METHOD: 82 patients (56.1% boys; 43.9% girls) of mean age 85.5 months were evaluated. They were divided into continent, partially continent and incontinent groups. Age, sex, manometric variables and profilometric parameters were studied. The results were statistically analyzed. RESULTS:Among the 82 patients, 37.8% were continent, 25.6% were partially continent and 36.6% were incontinent. The overall mean resting pressure was 22 mmHg, and the means for the continent, partially continent and incontinent groups were, respectively, 30.7 mmHg, 23 mmHg and 14.7 mmHg. The overall mean pressure response to voluntary contraction was 56 mmHg, and the means for the groups were 65.4 mmHg, 55.8 mmHg and 46.6 mmHg, respectively. The rectosphincteric reflex was absent in 82.9% of the cases. In the profilometry analysis for all patients together, blue (20 to 50 mmHg) and yellow (50 to 80 mmHg) were predominant, and there was a similar distribution for the continent and partially continent patients. However, among the incontinent patients, green (< 20 mmHg) and blue prevailed.CONCLUSIONS: Manometric and computerized profilometric analyses were an excellent method for postoperative evaluations on patients with intermediate and high anorectal anomalies, and for therapeutic planning.

Clinical, manometric and profilometric evaluation after surgery for Hirschsprung's disease: comparison between the modified Duhamel and the transanal rectosigmoidectomy techniques

“…As described by Vital Junior et al 12 , the existence of alterations on the pressure curves is suggestive of lesions in the anal canal. In our sample, there were no statistically significant differences in the enhanced pressure curves when the two surgical techniques were compared.…”

“…They reported that short anal canals (< 1.2 cm) generally offered little resistance and had a high sensitivity threshold. Both of these characteristics were associated with fecal incontinence 12 . This mechanical resistance was related to radial pressure in the anal canal and to the length of the anal canal.…”

“…It depends on the compliance of the rectal reservoir, presence of complete sphincter barriers, anorectal sensitivity and preservation of the pelvic reflexes 11,12,13,14 . The upper portion of the anal canal, corresponding to the region of the loop of the puborectal muscle, contributes significantly towards maintaining continence and has great importance in picking up the feeling of rectal fullness through the rectoanal transitional epithelium.…”

“…The resting pressure is the predominant factor in maintaining fecal continence 12,13,14 . It is the manometric translation of the internal and external sphincter muscle contraction, such that the internal sphincter is responsible for 85% of this pressure, while the external sphincter is only responsible for 15% 13 .…”

“…to determine its profilometry. The analysis of these data can be transformed into a mathematical expression of sphincter symmetry, measured under resting pressure conditions or during maximum voluntary contraction 12,14 .…”