Utility of postoperative anorectal manometry in children with anorectal malformation: a systematic review

Rajasegaran, Suganthi; Tan, Wei; Ezrien, Don Evana; Sanmugam, Anand; Singaravel, Srihari; Nah, Shireen Anne

doi:10.1007/s00383-022-05152-9

Cited by 5 publications

(2 citation statements)

References 22 publications

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“…The mechanisms of RAIR and the neural pathways of reflex have remained unknown, though its prominent role in normal defecation and sensation is believed to depend upon the intrinsic intramural nerve network regulated by the sacral medullary [21]. A recent systematic review [22] concluded that the absence of RAIR indicated low quality or damage of the IAS, which might be due to poorly developed anorectal structures in ARMs patients with poor continence. In our series of ARMs studies, a higher incidence of negative RAIR and significantly lower HPZ-rest in the incontinence ARMs patients suggested poor sensation and weakness of their IASs.…”

Section: Discussionmentioning

confidence: 99%

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

Guo,

Zhao,

Zhang

et al. 2024

Anorectal Disorders - From Diagnosis to Treatment

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Three-dimensional high-definition manometry was used in evaluating anorectal function of 142 post-operative patients with anorectal malformations (ARMs), while 104 non-operative children as controls (CON) who were subdivided into different age groups. Data were collected on the functional length (HPZ-length), resting and squeeze pressure (HPZ-rest, HPZ-sqze), recto-anal inhibitory reflex (RAIR), and strength distribution of the anal canal. The results showed a gradual increase in anal canal function parameters with age in normal infants and children, suggesting that age should be considered as an essential factor when evaluating post-operative anorectal function in ARMs patients. Comparing with CON, a significant decrease in HPZ-rest was observed in all post-operative ARMs groups (p < 0.05). The majority of ARMs patients with incontinence had significantly lower HPZ-rest and a higher percentage of asymmetric strength distribution compared to those with continence (p < 0.05). The type classification of high and cloaca in ARMs, as well as low HPZ-rest, were identified as two factors affecting post-operative functional outcomes. Manometry is a valuable modality providing distinct details of anal function in the assessment of the underlying functional causes of postoperative defecation disorder, thus helping physicians select the right modality of treatment. Sequential manometry studies are useful for re-evaluating anal function after treatment and biofeedback training.

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Section: Discussionmentioning

confidence: 99%

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

Guo,

Zhao,

Zhang

et al. 2024

Anorectal Disorders - From Diagnosis to Treatment

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“…It is believed that the RAIR mainly depends on the intrinsic intramural nerve network regulated by the sacral medullary (17). In a systematic review, Rajasegaran (18) summarized several papers and concluded that the absence of RAIR in the poor continence group might indicate low quality or damage of the IAS, which may already be poorly developed in patients with ARMs. Similar results were seen in our present study, with a higher incidence of negative RAIR and a significantly lower HPZ-rest in the incontinence patients, suggesting the poor sensation and weakness of their IAS.…”

Section: Discussionmentioning

confidence: 99%

Three dimension high definition manometry evaluated postoperative anal canal functions in children with congenital anorectal malformations

et al. 2023

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BackgroundWe aimed to evaluate the function of the reconstructed anal canal in postoperative anorectal malformations (ARMs) patients through three dimension (3D) high-definition anorectal manometry.MethodsFrom January 2015 to December 2019, 3D manometry was performed as a postoperative functional assessment of patients with ARMs divided into age subgroups based on the time of manometry. Manometric parameters, such as the length of the anorectal high-pressure zone (HPZ-length), the mean resting and squeeze pressure of HPZ (HPZ-rest and HPZ-sqze), recto-anal inhibitory reflex (RAIR), and strength distribution of the anal canal, were collected and compared with age-matched controls. Their functional outcomes were analyzed with SPSS 23.0 software for statistical analysis.Results171 manometric measurements were performed on 142 postoperative patients (3 months∼15 years). The HPZ-rest in all patients was significantly lower than in age-matched controls (p < 0.05). HPZ-sqze was notably decreased in patients older than 4 years, whereas other age groups were comparable to controls (p < 0.05). The proportions of asymmetric strength distribution and negative RAIR were higher in ARMs patients. The type of anorectal malformations and lower HPZ-rest were the impact factors affecting postoperative functional outcomes.ConclusionsThe majority of the ARMs patients had acceptable functional outcomes. 3D manometry can objectively assess the reconstructed anal canal function. The patients with fecal incontinence had a high proportion of extremely low HPZ-rest and HPZ-sqze, negative RAIR, and asymmetric strength distribution. The manometric details will help the clinicians explore the causes of defecation complications and guide further management.

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Experiences of youth growing up with anorectal malformation or Hirschsprung’s disease: a multicenter qualitative in-depth interview study

Rajasegaran,

Chandrasagran,

Tan

et al. 2024

Pediatr Surg Int

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Utility of postoperative anorectal manometry in children with anorectal malformation: a systematic review

Cited by 5 publications

References 22 publications

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

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

Three dimension high definition manometry evaluated postoperative anal canal functions in children with congenital anorectal malformations

Experiences of youth growing up with anorectal malformation or Hirschsprung’s disease: a multicenter qualitative in-depth interview study

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