Postoperative Fecoflowmetric Analysis in Patients with Anorectal Malformation

Abstract

Because conventional methods of evaluating anorectal function do not necessarily provide good correlations between investigative results and symptoms in patients who have undergone surgery for an anorectal malformation (ARM), we recently introduced feco-flowmetry (FFM) to simulate natural anorectal evacuation. The purpose of this study was to embody significant parameters to elucidate the dynamics of anorectal activity on FFM. The parameters of FFM were compared with those of manometry and Kelly's clinical score (KCS) in 24 patients who underwent surgery for an ARM. There were three fecoflow patterns, namely, block (B) type, segmental (S) type, and flat (F) type. The B-type or S-type patterns were seen in patients classified as "clinically good." There were close relationships between the fecoflow pattern and both the operative procedure and the KCS (P = 0.01 and 0.001, respectively). Maximum fecal stream flow rate (Fmax) precisely reflected the tolerance rate of intended normal saline solution in the colorectum (TR), the evacuative rate (ER), and KCS. Fmax > 45 ml/s or TR > 70% or ER > 50% was statistically regarded as the borderline of fecal continence. Thus, the fecoflow pattern might reflect the motor activity of the pelvic floor muscle. FFM provided quantiative and qualitative evaluations concerning anorectal motor activity in patients who had undergone surgery for an ARM.

Fecoflowmetric Analysis of Anorectal Motor Function in Postoperative Anal-Preserving Surgery Patients With Low Rectal Cancer Comparison With the Wexner Score and Anorectal Manometry

“…The fecoflow pattern (FFP) was classified according to Yagi's report. 8 The curve of the ''block type'' showed a hump shape without segmentation, and the Fmax was above 45 mL/s. The curve of the ''segmental type'' showed some segmental areas, and the Fmax was above 15 mL/s.…”

“…[8][9][10][11][12][13] To imitate stool movement, a normal saline enema was instilled at 378C with a volume of 1000 mL under gravity through a 6-Fr catheter, in the left lateral position, while the anorectal pressure was monitored. When the urge to defecate could no longer be suppressed or major leakage of the imitated stool, or severe abdominal pain developed, the normal saline instillation was discontinued.…”

“…When the urge to defecate could no longer be suppressed, the patient sat on the seat of the FFM and was left alone while defecating to obviate any psychologic inhibitory factors. 8,9 The tolerance volume [TV (mL)] of the normal saline solution in the rectum, evacuative volume [EV (mL)], and maximum fecal stream flow rate [Fmax (mL/s)] in the FFM were measured according to Yagi's method. 8,9 After these measurements were performed, the evacuative rate [ER: (EV/TV) 3 100 (%)] was calculated.…”

“…Although manometry with or without the clinical score has also commonly been used, fecoflowmetry (FFM) has been reported to be more accurate and useful for assessing the postoperative anorectal motor function. [8][9][10][11][12][13] FFM was first introduced by Shafik and is a dynamic method for examining the anorectal motor activity that simulates the natural act of defecation.…”

“…14 Some studies have shown its usefulness in postoperative patients with anorectal disease, [8][9][10][11] but only a few studies have been performed to examine the evacuative function following analpreserving surgery. 12,13 The aim of this study was to evaluate the evacuative function in the postoperative period following anal-preserving surgery in patients with low rectal cancer using FFM, and to compare the results with the Wexner score and anorectal manometry.…”