Factors That Influence Bowel Function In 45 Children With High And Intermediate Anorectal Malformations

ObjectiveThe aim of this study was to investigate the factors that influence bowel function after reconstructive surgery in children with high and intermediate anorectal malformations(ARMs) and to provide a reference for the prognostic evaluation and prevention of bowel dysfunction.MethodsForty-five patients with high and intermediate anorectal malformations were analyzed retrospectively, and the relationship between defecation function and the distance between the rectal blind end and the anal fossa, the development of the muscles around the rectum, the enteric nervous system and nerve dysplasia were studied.ResultsForty-five patients, including 35 males and 10 females, were divided into normal, good, fair and poor groups according to their defecation function after surgery; there were 11 patients in the normal group, 19 in the good group, 15 in the fair group, and 0 in the poor group. Our results showed that a third of children had postoperative bowel dysfunction.(1) The distances between the rectal blind end and the anal fossa in the groups were 15.50±3.25 mm, 27.14±3.11 mm and 39.2±19.02 mm respectively, and there were significant differences between the three groups(P<0.05).(2)The development of the muscles around the rectum was evaluated during surgery; the normal group exhibited normal development,whereas the patients in the fair group had the worst muscle development. There were significant differences between the three groups(P<0.05).(3) Spinal defects were detected in 10 patients by MRI. The bowel function in these patients after surgery was significantly different than that in the children with no spinal abnormalities(P<0.05).(4) The results of the immunohistochemical staining showed that 6 patients in the rectum blind end normal ganglion cell group, 16 patients in the lesion group, and 2 patients in the nonganglion cell group were CR positive. The rank-sum test showed that there was a significant difference in the defecation function between groups(P<0.05).(5) Twenty-seven patients received an anorectal manometry after the surgery to close a fistula, and there were no significant differences in the anal resting pressure and rectal inhibitory reflex(RAIR) between groups(P>0.05).(6) Thirty-seven patients received endoanal ultrasonography after the surgery to close the fistula, and the thicknesses of the internal and external sphincters were 1.06±0.16 mm and 3.02±0.27 mm respectively. There were no significant differences in the thicknesses of the internal and external sphincters between the ARMs group and the control group(P>0.05). The ARMs defecation function was evaluated after the operation, and there were no significant differences between the internal sphincter groups and external sphincter groups(P>0.05).(7) Postoperative complications occurred and were cured in five patients with rectal prolapse and one with an infected wound in the sacral position. The bowel function between the complication and without complications groups was compared, and there was no significant difference(P>0.05).(8) Cardiovascular system malformations and genitourinary defects were the most commonly associated malformations, though in some cases, cardiac malformations and genitourinary anomalies can be self-correcting.ConclusionBowel function may be affected by the distance between the rectal blind end and the anal fossa, the development of the muscles around the rectum, the enteric nervous system and the spinal development of patients with high and intermediate anorectal malformations. The key to the prevention of dysfunction is a comprehensive assessment of the disease during the first visit, proper surgical procedures, and regular, long-term follow-up after surgery.