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Postoperative continence assessed by electromyography of the external sphincter in anorectal malformations
Insights
Electromyography (EMG) assessed voluntary fecal continence in patients with anorectal malformations. High-type anomalies showed disturbed external sphincter function, but training may improve continence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neuroscience
Background:
- Anorectal malformations (ARMs) present significant challenges to voluntary fecal continence.
- Assessing external sphincter muscle function is crucial for understanding continence outcomes after corrective surgery.
Purpose of the Study:
- To evaluate voluntary fecal continence using electromyography (EMG) of the external sphincter muscle in patients with ARM.
- To correlate EMG findings with clinical continence scores (Kelly scores).
Main Methods:
- EMG of the external sphincter muscle was performed on 20 patients with ARM and 6 healthy controls.
- Analysis focused on tonic activity, rectoanal inhibitory reflex (RAIR), and response to rectal distension.
Main Results:
- Patients with high-type ARM exhibited impaired tonic activity, RAIR, and rectal filling responses.
- A positive RAIR correlated with good Kelly scores across all ARM types.
- Phasic activity was present in high-type ARM patients, normal subjects, and other ARM types.
Conclusions:
- External sphincter dysfunction in high-type ARM can impact voluntary fecal continence.
- The presence of a positive RAIR is a positive prognostic indicator for continence.
- Compensatory voluntary anal continence may be achievable in high-type ARM patients through targeted training.
Abstract:
Voluntary faecal continence after corrective surgery for anorectal malformations was assessed via electromyography (EMG) of the external sphincter muscle in 20 patients with anorectal malformations. Six normal children served as controls. Function of the external sphincter in patients with high type anomaly was disturbed from the points of tonic activity, inflation reflex, and activity during further rectal filling. Patients with a positive inflation reflex, regardless of the type of anorectal malformation, had good Kelly scores. Phasic activity was observed in patients with high-type anomaly, and in normal subjects and patients with other types of anomaly. Therefore, patients with high-type anomaly may acquire compensatory voluntary anal continence through training.