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High and intermediate imperforate anus: functional results and postoperative manometric assessment
P Mollard1, P Meunier, P Mouriquand
1Department of Pediatric Surgery, Hôpital Debrousse, Lyon.
Summary
This study on imperforate anus surgery found satisfactory anatomical results in 20/21 patients. Long-term follow-up showed good daytime bowel control, with manometric studies offering insights into rectoanal inhibitory reflex threshold and rectal compliance.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Pediatric Gastroenterology
Background:
- Imperforate anus is a congenital condition requiring surgical correction.
- Assessing long-term functional outcomes post-correction is crucial for patient management.
Purpose of the Study:
- To evaluate the anatomical and functional outcomes of a specific surgical procedure for high and intermediate imperforate anus.
- To assess the utility of manometric studies in understanding bowel function after pull-through procedures.
Main Methods:
- Retrospective review of 21 patients (1983-1989) with high/intermediate imperforate anus.
- Clinical and paraclinical assessments, including manometry, in 13 patients with ≥5 years follow-up.
- Manometric parameters studied: rectoanal inhibitory reflex threshold (RAIRT), maximal anal resting closure pressure (MARCP), conscious rectal sensitivity threshold (CRST), and maximal rectal compliance (MRC).
Main Results:
- Satisfactory anatomical results in 20/21 patients.
- 12/13 patients achieved nighttime continence with 1-3 daily bowel movements.
- Manometry showed RAIRT present in 3/6 intermediate and 3/7 high forms; CRST normal in 12/13; MARCP normal in 5/6 intermediate and 5/7 high forms; MRC good in 5/6 intermediate and 3/7 high forms.
Conclusions:
- The author's surgical procedure yields satisfactory anatomical results for imperforate anus.
- Long-term functional outcomes are generally favorable, though high-form imperforate anus may present with soiling.
- Manometric studies provide valuable data on rectal sensitivity, anal closure, and rectal compliance, aiding in the understanding of functional outcomes.