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The anal sphincter force in the evaluation of postoperative imperforate anus
B Shandling1, R Gilmour, S Ein
1Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Anal sphincter force (ASF) measurement helps assess fecal incontinence in children with imperforate anus. Low ASF correlates with incontinence, while high ASF indicates continence, aiding treatment comparisons.
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Background:
- Imperforate anus is a congenital condition requiring surgical correction.
- Assessing fecal incontinence post-correction is crucial for patient outcomes.
- Objective measures for anal sphincter function are needed.
Purpose of the Study:
- To evaluate the utility of anal sphincter force (ASF) measurement in children with imperforate anus.
- To correlate ASF with clinical continence and type of imperforate anus.
- To establish ASF as an objective tool for evaluating fecal incontinence.
Main Methods:
- Eighty-four children with imperforate anus were assessed.
- Anal sphincter force (ASF) was measured in grams (g).
- ASF values were compared between different types of imperforate anus and clinical continence status.
Main Results:
- Boys with high imperforate anus had lower ASF (50-300 g) compared to normal values (480-600 g).
- Boys and girls with low imperforate anus demonstrated high ASF readings and were continent.
- Children with high imperforate anus who underwent posterior sagittal anorectoplasty showed lower ASF and were not continent.
Conclusions:
- Anal sphincter force (ASF) is a simple, objective measure for fecal incontinence in imperforate anus.
- Low ASF indicates muscular inadequacy and fecal incontinence.
- High ASF readings correlate with continence in low imperforate anus cases, providing a quantifiable outcome measure.
Abstract:
Eight-four children, all of whom had imperforate anus, were evaluated by measuring the anal sphincter force (ASF). Sixty-three were boys, 46 of whom had a high imperforate anus and 17 of whom had the low anomaly. There were 7 girls with cloacal malformations, 7 girls with high type and 7 with low type of malformation. In all the boys with a high imperforate anus the ASF ranged from 50 to 300 g. Those boys with a low type had an average ASF of 513 g. Normal values vary from 480 to 600 g. Twenty-five of the boys with a high imperforate anus had undergone posterior sagittal anorectoplasty and none were clinically continent. Their ASF measurements were lower than in patients with spina bifida. Patients with a low anomaly, both boys and girls, were continent and had high ASF readings. The ASF is a simple, inexpensive, and objective measurement of fecal incontinence when this is the consequence of muscular inadequacy. A reproducible quantification is now available to compare results of different operations and different centres.