Evaluation Of Postoperative Anal Functions Using Endoanal Ultrasonography And Anorectal Manometry In Children With Congenital Anorectal Malformations

ObjectiveTo use of endoanal ultrasonography (EUS) and anorectal manometry as objective indicators to evaluation the the anorectal anatomy and function in children with congenital anorectal malformations (ARM). Combined with clinical anal function score, to investigate the correlation between subjective and objective indicators, further to guide the clinical individualized rehabilitation.MethodsThis study included 47 children who had undergone Surgery for the repair of an ARM, objective indicators to evaluation the the anorectal anatomy and function (endoanal ultrasonography、anorectal manometry),measuring the thickness of internal sphincter, the balloon volume, etc. All children were take clinical scoring system.1 According to subjective ratings were divided into good group, intermediate anoplasty group and the poor group,and internal anal sphincter thickness of the three groups was compared.2 Children were divided into operation group and control group according to whether to have surgery,and internal anal sphincter thickness of the two groups was compared.3 Children were divided into Pena group and perineal anoplasty group according to different operation mode, and internal anal sphincter thickness of the two groups was compared.4 Children were divided into low group and intermediate/high group, according to Clinical pathological type,and groups of the balloon volume were analyzed.5 To correlation analysis of objective assessment and subjective assessment with children who had undergone surgery for the repair of an ARM.The control group were ten children (range,2.17-9.17 years) with no history of anal or rectal diseases served as healthy controls.Results1 The good group, intermediate anoplasty group and the poor group of internal sphincter thickness were:1.31±0.32mm、1.33±0.37mm、 1.41±0.13mm; Comparison between groups F=0.228, P=0.797,there were no significant differences in the thickness of the interior sphincters between the good group, intermediate anoplasty group and the poor group.2 The operation group and control group of internal sphincter thickness were:1.33±0.31mm、1.06±0.16mm; Comparison between groups P=0.012, there were significant differences in the thickness of the interior sphincter between the the operation group and control group.3 The Pena group and perineal anoplasty group of internal sphincter thickness were:1.40±0.38mm、1.25±0.21m; Comparison between groups P=0.099, there were no significant differences in the thickness of the interior sphincter between the Pena group and transperineal anorectoplasty group.4 The low group,intermediate/high groups of the balloon volume were: (37.14±10.49)ml, (44.74±11.24)ml; Comparison between groups P=0.022, there were significant differences in the balloon volume between the low group, and intermediate/high groups.5 On anorectal manometry, balloon volume was significantly correlated with anal function scores,r=-0.30, P=0.043.ConclusionThere were differences in the thickness of the interior sphincter between the children with congenital anorectal malformation and normal children. EUS and anorectal manometry are accurate for postoperative assessment of anorectal anatomy and function in children with ARM. Combined with clinical anal function score will be further to guide the clinical individualized rehabilitation.