Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 9;10(6):1037.
doi: 10.3390/children10061037.

Evaluation of Anal Sphincter with High Resolution Anorectal Manometry and 3D Reconstruction in Patients with Anorectal Malformation

Anna Maria Caruso  1 , Denisia Bommarito  1 , Vincenza Girgenti  1 , Glenda Amato  1 , Ugo Calabrese  1 , Adele Figuccia  2 , Fabio Baldanza  2 , Francesco Grasso  2 , Emanuela Giglione  3 , Alessandra Casuccio  2 , Mario Pietro Marcello Milazzo  1 , Maria Rita Di Pace  2
Affiliations

Evaluation of Anal Sphincter with High Resolution Anorectal Manometry and 3D Reconstruction in Patients with Anorectal Malformation

Anna Maria Caruso et al. Children (Basel). .

Abstract

Background: Patients with anorectal malformation (ARM) need long-term follow-up, in order to evaluate fecal continence; the main predictors of longer-term success are the type of ARM, associated anomalies and sacral integrity. Three-Dimensional High Resolution Anorectal Manometry (3D-HRAM) gives detailed information on pressure on the anal complex profile. Our objective was to analyze anal sphincter activity in ARM patients with 3D-HRAM establishing the correlation between manometric and clinical data.

Methods: Forty ARM patients were submitted to 3D-HRAM: manometric, anatomical and clinical scores were correlated with each other and with the bowel management response (BM).

Results: A positive correlation between all scores and types of ARM was found: in high ARM and in patients with spinal anomalies (regardless to ARM type) lower scores were reported and even after BM they did not achieve good continence.

Conclusions: 3D-HRAM gives detailed data on the functional activity of the anal sphincter complex. Our study revealed a correlation between manometric parameters and clinical outcomes, confirming spinal malformations and ARM type as the most important prognostic risk factors for a bad outcome. Specific sphincteric defects can also be explored with manometry, allowing for tailored bowel management strategies.

Keywords: anorectal malformations; bowel management; fecal incontinence; high resolution anorectal manometry.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial conflict of interest to declare.

Figures

Figure 1
Figure 1
(A) Correlation between EO score and response to bowel management. (0: Poor; 1: discrete; 2: excellent). EO: extern anatomic objective score. (B) Correlation between HRM score and response to bowel management. (0: Poor; 1: discrete; 2: excellent).
Figure 2
Figure 2
The image shows the 3D manometric reconstruction of the anal canal at rest and after squeeze (images below) in patients without (A) and with (B) sphincter defect. (A): patient with low Anorectal Malformation: sphincter has a good pressure value and symmetry; after voluntary contraction, the pressure increment is good for amplitude and symmetry. (B): patient with high Anorectal Malformation: sphincter hypotonus and asymmetry with low pressure in anterior, right and left segments at rest; during voluntary contraction (squeeze) the pressure increases but not uniformly.
See this image and copyright information in PMC

References

    1. King S.K., Krois W., Lacher M., Saadai P.M., Armon Y., Midrio P. Optimal management of the newborn with an anorectal malformation and evaluation of their continence potential. Semin. Pediatr. Surg. 2020;29:150996. doi: 10.1016/j.sempedsurg.2020.150996. - DOI - PubMed
    1. Masi P., Miele E., Staiano A. Pediatric anorectal disorders. Gastroenterol. Clin. N. Am. 2008;37:709–730. doi: 10.1016/j.gtc.2008.07.002. - DOI - PubMed
    1. Rintala R.J., Pakarinen M.P. Imperforate anus: Long- and short-term outcome. Semin. Pediatr. Surg. 2008;17:79–89. doi: 10.1053/j.sempedsurg.2008.02.003. - DOI - PubMed
    1. Bischoff A., Levitt M.A., Peña A. Update on the management of anorectal malformations. Pediatr. Surg. Int. 2013;29:899–904. doi: 10.1007/s00383-013-3355-z. - DOI - PubMed
    1. Arnoldi R., Macchini F., Gentilino V., Farris G., Morandi A., Brisighelli G., Leva E. Anorectal malformations with good prognosis: Variables affecting the functional outcome. J. Pediatr. Surg. 2014;49:1232–1236. doi: 10.1016/j.jpedsurg.2014.01.051. - DOI - PubMed