Internal sphincter-saving in imperforate anus with or without fistula. A manometric study

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Anorectal Malformations

Background:

• Congenital anorectal anomalies present diverse challenges in surgical correction.
• The functional integrity of the internal sphincter is critical for continence.
• Previous surgical approaches may have compromised sphincter preservation.

Purpose of the Study:

• To evaluate the manometric function of the internal sphincter in infants with congenital anorectal anomalies.
• To assess the impact of surgical correction, specifically sphincter preservation and transplantation, on anorectal function.
• To emphasize the importance of preserving the internal sphincter for optimal surgical outcomes.

Main Methods:

• Manometric assessment in 54 infants with various types of congenital anorectal anomalies.
• Preoperative and/or postoperative evaluation based on the orifice's accessibility.
• Surgical technique involved preserving and transplanting the ectopic rectal opening with its smooth musculature.

Main Results:

• All infants demonstrated a normally functioning internal sphincter post-transplantation.
• Normal anal resting tone (32-51 mmHg) and anal slow pressure wave activity (11.6-15.7/min) were observed.
• The recto-anal inhibitory reflex was consistently present in all cases.

Conclusions:

• Preservation and appropriate transplantation of the internal sphincter are vital for successful surgical correction of anorectal anomalies.
• Manometric assessment confirms the functional integrity of the preserved sphincter.
• Understanding and maintaining the internal sphincter's role can prevent poor functional results after surgery.