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Prognostic evaluation of biofeedback response in patients treated for anorectal malformation
A M Caruso1, P Catalano1, G Li Voti1
1Pediatric Surgical Unit, Department of Mother and Child Care, University of Palermo, Palermo, Italy.
Insights
Biofeedback (BFB) training shows effectiveness in improving fecal incontinence in children with anorectal malformation (ARM). Pre-treatment assessments of manometry and MRI can predict successful outcomes, guiding treatment strategies for better bowel function.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Rehabilitative Medicine
Background:
- Functional bowel outcomes in patients with anorectal malformation (ARM) are frequently poor.
- Fecal incontinence, often due to sphincter dysfunction in ARM patients, may benefit from biofeedback (BFB) training.
Purpose of the Study:
- To investigate bowel function in incontinent children treated for ARM.
- To identify predictive parameters for biofeedback response using clinical scores, manometry, and pelvic MRI.
Main Methods:
- 25 children with fecal incontinence underwent clinical scoring, anorectal manometry, and MRI.
- Patients were categorized into four groups based on manometry and MRI findings.
- All groups received biofeedback training and were reassessed post-treatment.
Main Results:
- Overall response to BFB was excellent in 44%, discrete in 40%, and poor in 16%.
- Groups with favorable manometry and MRI showed better BFB response.
- Pre-treatment assessments correlated with post-treatment outcomes and associated anomalies.
Conclusions:
- Biofeedback is effective for fecal incontinence in ARM when pre-treatment functional and morphologic assessments are favorable.
- Manometry can assess sphincterial recovery potential post-BFB.
- Correlating manometry with MRI provides enhanced prognostic value.
Purpose:
Functional bowel outcome in patients with anorectal malformation often is poor. For fecal incontinence resulting from sphincter dysfunction, biofeedback (BFB) training appears to be effective. The aim of study was to investigate the bowel function in incontinent children treated for ARM, using a clinical score, a manometric and pelvic magnetic resonance evaluation, in order to establish predictive parameters of response after BFB.
Methods:
25 children (median age of 6.5 years) with true fecal incontinence were evaluated by clinical score, anorectal manometry and magnetic resonance imaging (MRI). According to these evaluations patients were divided in 4 groups: group 1 (favorables manometry and MRI); group 2 (favorable manometry and unfavorable MRI); group 3 (unfavorable manometry and favorable MRI); group 4 (unfavorables manometry and MRI). All groups started a cycle of BFB and six months after end of BFB, were reevaluated by clinical score and manometry.
Results:
The overall response to BFB was excellent in 44%, discrete in 40% and poor in 16%; a better response was found in groups 1 and 2 than groups 3 and 4. The differences between groups before BFB proportionally correlated with values after BFB; a correlation with genitourinary and spinal anomalies was found.
Conclusions:
Our results showed that BFB is an effective for fecal incontinence when the assessment pretreatment (functional and morphologic) is favorable; the manometry can evaluate the potential sphincterial recovery after BFB with a further prognostic benefit if correlated to morphologic evaluation with MRI.
