Background: Surgical correction of congenital anorectal malformations could be complicated by fecal incontinence. Some authors believe that preservation of the fistula is associated with improved outcome. Rectal manometry is a well-established method to evaluate postoperative functional outcome in these patients and can demonstrate successful transplantation of the fistula.
Objective: Herein, we report the results of our series of patients with anorectal malformations and an externally accessible fistula, who underwent pre- and postoperative rectal manometry studies.
Design: This is a prospective cohort study.
Settings: This study was conducted at a tertiary neonatal and pediatric surgical center.
Patients: Patients with anorectal malformations, who underwent preoperative rectal manometry of the fistula and postoperative rectal manometry of the neoanus between January 2002 and December 2011 were included.
Main Outcome Measures: Pre- and postoperative rectal manometry results were compared by using paired t test or contingency tables (p values <0.05).
Results: Twelve female patients with rectoperineal (n = 7, 58%) or rectovestibular (n = 5, 42%) fistula were treated by anterior sagittal anorectoplasty or minimal posterior sagittal anorectoplasty. Complete transposition of the fistula was achieved in all patients. Normal presence of rectoanal inhibitory reflex was demonstrated in all pre- and postoperative rectal manometry studies. There were no differences between pre- and postoperative rectal manometry in the length of the high-pressure zone (2.3 ± 0.6 cm vs 2.5 ± 0.8 cm (p = 0.5)) and resting pressure (59.4 ± 18.2 mm Hg vs 62.1 ± 19.2 mm Hg (p = 0.62)). At a median follow-up of 665 days (range, 290-1165 days), all patients have voluntary bowel movements, with no incontinence or soiling.
Limitations: This study is limited by its small sample size and by single-institution bias.
Conclusion: Preoperative rectal manometry of rectoperineal or rectovestibular fistula showed the presence of functional anal structures within the fistula in all patients. We speculate that fistula-preserving surgery in patients with anorectal malformations is associated with improved bowel function outcome.
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http://dx.doi.org/10.1097/DCR.0b013e31826e4a38 | DOI Listing |
Surg Endosc
January 2025
Department of Surgery, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Background: The quality of life after surgery for diverticular disease is mainly linked to the presence and severity of postoperative defecatory disorders. These symptoms are frequently related to the sigmoid and rectal denervation following the arterial ligation. The preservation of Inferior Mesenteric Artery performing colorectal resections seems to reduce denervation, which led to a better defecatory function.
View Article and Find Full Text PDFHigh-resolution anorectal manometry (HR-ARM) is the gold standard for anorectal functional disorders' evaluation, despite being limited by its accessibility and complex data analysis. The London Protocol and Classification were developed to standardize anorectal motility patterns classification. This proof-of-concept study aims to develop and validate an artificial intelligence model for identification and differentiation of disorders of anal tone and contractility in HR-ARM.
View Article and Find Full Text PDFJGH Open
January 2025
Service de Gastroentérologie, Hôpital NORD, Assistance Publique Hôpitaux de Marseille Aix-Marseille Université Marseille France.
Background And Aims: Diagnosing dyssynergic disorders (DD) often requires 3D high-definition anorectal manometry (3D-HRAM), raising concerns about cost, availability, and delayed referral. Digital rectal examination (DRE) offers a reliable, cost-effective alternative for DD diagnosis. This study aimed to assess DRE's capability to classify DD patients into the four subtypes outlined in Rao's classification.
View Article and Find Full Text PDFAm J Gastroenterol
January 2025
Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autònoma de Barcelona), Carretera de Cirera s/n 08304, Mataró, Spain.
Background: Fecal incontinence (FI) is a prevalent condition that disproportionately impacts women. Although sphincter biomechanics are well studied, the integrity of the cortico-anal motor pathway remains elusive. We evaluated the cortico-spino-anorectal pathway in women with FI against age-matched (AM-HV) and young healthy (Y-HV) volunteers.
View Article and Find Full Text PDFAm J Gastroenterol
January 2025
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Background: Hindgut symptoms are poorly understood complications of obesity. The impact of obesity on fecal incontinence (FI) and anorectal physiology remains unclear, with inconsistent results in prior studies. We aimed to evaluate the relationship between obesity and FI, and the physiological changes in anorectal function.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!