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Published on: April 17, 2019
Functional Outcomes of Patients Who Underwent Anorectal Malformation Repair Using MRI Guidance
Danielle Dougherty1, Matthew W Ralls2, Connor J Plagens3
1University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, United States; Connecticut Children's Hospital, Department of Surgery, Section of Pediatric Surgery, 282 Washington Street, Hartford, CT 06106, United States.
Insights
Magnetic resonance imaging (MRI) guided anorectal malformation repair shows promise for improving bowel function in children. This technique aids in precise neoanus placement, potentially reducing long-term bowel management needs.
Area of Science:
- Pediatric Surgery
- Medical Imaging
- Reconstructive Surgery
Background:
- Anorectal malformation (ARM) repair often results in persistent functional bowel issues like constipation and incontinence in children.
- Minimally invasive laparoscopic techniques have not fully resolved these post-operative challenges.
Purpose of the Study:
- To evaluate the functional outcomes of ARM repair using magnetic resonance imaging (MRI) guidance.
- To assess if MRI guidance improves neoanus placement and subsequent bowel function.
Main Methods:
- Retrospective chart review of patients undergoing MRI-guided laparoscopic ARM repair.
- Telephone survey utilizing the Baylor Continence Scale to assess social continence.
- Analysis of bowel management strategies (none, laxatives, enemas).
Main Results:
- Twenty-six patients were analyzed with a median follow-up of 4 years.
- 58% of patients used laxatives only, 23% used enemas, and 19% required no bowel management.
- The Baylor Continence Scale showed a median score of 14 among 58% of surveyed patients, with no significant correlation to lesion level or surgical quality.
Conclusions:
- MRI guidance in ARM repair demonstrates potential for improving both qualitative and quantitative functional outcomes.
- This technique offers a promising approach for managing this complex pediatric surgical condition.
Background:
Despite the initiation of minimally invasive laparoscopic techniques, the majority of patients who undergo anorectal malformation repair still experience functional bowel issues in childhood, including constipation and fecal incontinence. In this study, we evaluate the functional outcomes of a procedure in which magnetic resonance imaging guidance is used during initial laparoscopic repair to better locate the epicenter of the sphincter muscle complex and pelvic floor with the goal of more accurate placement of the neoanus and improved functional outcomes.
Methods:
A retrospective chart review evaluated demographic, operative, and outcome details for patients who underwent this procedure. A telephone survey was employed to determine levels of social continence using the validated Baylor Continence Scale and to determine what type of bowel management is used.
Results:
Twenty-six patients were included. Median age at operation was 7 months, and median age at follow-up was 4 years old, with a range of 1-9. Bowel management regimen results revealed that 19 % (n = 5) use no bowel management regimen, 58 % (n = 15) use laxatives only, and 23 % (n = 6) use enemas. Enema use was not associated with different spine or sacral anomalies (p = 0.77). Fifteen patients (58 %) answered the Baylor Continence Scale questions and had a median score of 14. No difference was found in scores when accounting for lesion level (p = 0.43), quality of needle placement (p = 0.46), or quality of sphincter muscles (p = 0.75).
Conclusions:
Using MRI guidance in the repair of anorectal malformations shows promise in both the qualitative and quantitative functional outcomes of this complex patient population.
Level Of Evidence:
Level III.
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