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Anorectal Malformations: Anorectal Manometric and Endosonographic Combined Approach

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Ano-Rectal Endosonography and Manometry in Paediatrics

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Abstract

Outcomes of anorectal malformations (ARMs) are influenced by the type of malformation and the associated anomalies.

A high proportion of these patients often complain of alterations of bowel movements (constipation, pseudo-incontinence or faecal incontinence) with poor quality of life.

A personalised bowel management programme needs a careful assessment of bowel and anal sphincters, in addition to an evaluation of any associated malformations.

Anorectal manometry and endoanal ultrasonography ensure, respectively, a functional and anatomical study of anal sphincters.

Recent technological innovations, particularly the advent of high-resolution and high-definition anorectal manometry and the three-dimensional reconstruction of the endosonographic images, have enhanced the accuracy in depicting pressures and muscular lesions of anal sphincters.

The studies performed so far on children with ARMs have documented different grades of sphincter injuries with alterations in resting and squeezing pressures and absence of recto-anal inhibitory reflex.

Data obtained are not homogeneous because of the clinical variability of these patients, the small series studied and the different diagnostic systems used.

However, a systematic manometric and endosonographic evaluation is recommended in ARMs’ patients to correctly identify the pathophysiology of anorectal disorders, in order to improve treatments and functional results.

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References

  1. Rigueros Springford L, Connor MJ, Jones K, Kapetanakis VV, Giuliani S. Prevalence of active long-term problems in patients with anorectal malformations: a systematic review. Dis Colon Rectum. 2016;59:570–80. https://doi.org/10.1097/DCR.0000000000000576.

    Article  PubMed  Google Scholar 

  2. Ludman L, Spitz L, Kiely EM. Social and emotional impact of fecal incontinence after surgery for anorectal abnormalities. Arch Dis Child. 1994;71:194–200.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Minneci PC, Kabre RS, Mak GZ, Halleran DR, Cooper JN, Afrazi A, et al. Can fecal continence be predicted in patients born with anorectal malformations? J Pediatr Surg. 2019;54:1159–63. https://doi.org/10.1016/j.jpedsurg.2019.02.035.

    Article  PubMed  Google Scholar 

  4. Wood RJ, Marc A, Levitt MA. Anorectal malformations. Clin Colon Rectal Surg. 2018;31:61–70.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tantiphlachiva K. Comprehensive clinical approach to fecal incontinence. Book chapter doi: https://doi.org/10.5772/intechopen.86346.

  6. Frischer JS, Rymeski B. Complications in colorectal surgery. Semin Pediatr Surg. 2016;25:380–7. https://doi.org/10.1053/j.sempedsurg.2016.10.008.

    Article  PubMed  Google Scholar 

  7. Stephens FD, Smith ED. Classification, identification, and assessment of surgical treatment of anorectal anomalies. Pediatr Surg Int. 1986;1:200–5.

    Article  Google Scholar 

  8. Peña A. Anorectal malformations. Semin Pediatr Surg. 1995;4:35–47.

    PubMed  Google Scholar 

  9. Holschneider A, Hutson J, Peña A, Beket E, Chatterjee S, Coran A, et al. Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg. 2005;40:1521–6. https://doi.org/10.1016/j.jpedsurg.2005.08.002.

    Article  PubMed  Google Scholar 

  10. Gupta DK. Anorectal malformations—wingspread to Krickenbeck. J Indian Assoc of Pediatr Surg. 2005;10:75–7.

    Article  Google Scholar 

  11. Guillaume A, Salem AE, Garcia P, Chander RB. Pathophysiology and therapeutic options for fecal incontinence. J Clin Gastroenterol. 2017;51:324–30. https://doi.org/10.1097/MCG.0000000000000797.

    Article  CAS  PubMed  Google Scholar 

  12. Caldaro T, Romeo E, De Angelis P, Gambitta RA, Rea F, Torroni F, et al. Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: new discoveries. J Pediatr Surg. 2012;47:956–63.

    Article  PubMed  Google Scholar 

  13. Borg H, Bachelard M, Sillén U. Megarectosigmoid in children with anorectal malformations: long term outcome after surgical or conservative treatment. J Pediatr Surg. 2014;49:564–9. https://doi.org/10.1016/j.jpedsurg.2013.08.003.

    Article  PubMed  Google Scholar 

  14. Burjonrappa S, Youssef S, Lapierre S, Bensoussan A, Bouchard S. Megarectum after surgery for anorectal malformations. J Pediatr Surg. 2010;45:762–8. https://doi.org/10.1016/j.jpedsurg.2009.10.043.

    Article  PubMed  Google Scholar 

  15. Miyahara K, Kato Y, Seki T, Arakawa A, Lane GJ, Yamataka A. Neuronal immaturity in normoganglionic colon from cases of Hirschsprung disease, anorectal malformation, and idiopathic constipation. J Pediatr Surg. 2009;44:2364–8. https://doi.org/10.1016/j.jpedsurg.2009.07.066.

    Article  PubMed  Google Scholar 

  16. Holbrook C, Misra D, Zaparackaite I, Cleeve S. Postoperative strictures in anorectal malformation: trends over 15 years. Pediatr Surg Int. 2017;33:869–73. https://doi.org/10.1007/s00383-017-4111-6.

    Article  PubMed  Google Scholar 

  17. Kyrklund K, Pakarinen MP, Rintala RJ. Long-term bowel function, quality of life and sexual function in patients with anorectal malformations treated during the PSARP era. Semin Pediatr Surg. 2017;26:336–42. https://doi.org/10.1053/j.sempedsurg.2017.09.010.

    Article  PubMed  Google Scholar 

  18. Peña A, Bischoff A. Surgical treatment of colorectal problems in children. Springer; 2015. https://doi.org/10.1007/978-3-319-14989-9.

    Book  Google Scholar 

  19. Gurusamy R, Raj SV, Maniam R, Regunandan SR. Laparoscopic-assisted anorectoplasty: a single-center experience. J Indian Assoc Pediatr Surg. 2017;22:114–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Peña A, Hong A. Advances in the management of anorectal malformations. Am J Surg. 2000;180:370–6. https://doi.org/10.1016/s0002-9610(00)00491-8.

    Article  PubMed  Google Scholar 

  21. Pathak M, Saxena AK. Postoperative “complications” following laparoscopic-assisted anorectoplasty: a systematic review. Pediatr Surg Int. 2020;36:1299–307. https://doi.org/10.1007/s00383-020-04748-3.

    Article  PubMed  Google Scholar 

  22. Rodriguez L, Sood M, Di Lorenzo C, Saps M. An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children. Neurogastroenterol Motil. 2017;29:10.1111.

    Article  Google Scholar 

  23. Rasijeff AMP, Withers M, Burke JM, Jackson W, S. Scott SM. High-resolution anorectal manometry: a comparison of solid-state and water-perfused catheters. Neurogastroenterol Motil. 2017;29:e13124.

    Article  Google Scholar 

  24. Scott SM, Emma V, Carrington EV. The London classification: improving characterization and classification of anorectal function with anorectal manometry. Curr Gastroenterol Rep. 2020;22:–55. https://doi.org/10.1007/s11894-020-00793-z.

  25. Tambucci R, Quitadamo P, Thapar N, Zenzeri L, Caldaro T, Staiano A, Verrotti A, Borrelli O. Diagnostic tests in pediatric constipation. J Pediatr Gastroenterol Nutr. 2018;66(4):e89–98. https://doi.org/10.1097/MPG.0000000000001874.

    Article  PubMed  Google Scholar 

  26. Hedlund H, Peña A, Rodriguez G, Maza J. Long-term anorectal function in imperforate anus treated by a posterior sagittal anorectoplasty: manometric investigation. J Pediatr Surg. 1992;27:906–9.

    Article  CAS  PubMed  Google Scholar 

  27. Senel E, Demirbag S, Tiryaki T, Erdogan D, Cetinkursun S, Cakmak O. Postoperative anorectal manometric evaluation of patients with anorectal malformation. Pediatr Int. 2007;49:210–4. https://doi.org/10.1111/j.1442-200X.2007.02342.x.

    Article  PubMed  Google Scholar 

  28. Rintala RJ. Fecal incontinence in anorectal malformations, neuropathy, and miscellaneous conditions. Semin Pediatr Surg. 2002;11:75–82.

    Article  CAS  PubMed  Google Scholar 

  29. Lee TH, Bharucha AE. How to perform and interpret a high-resolution anorectal manometry test. J Neurogastroenterol Motil. 2016;31(22):46–59. https://doi.org/10.5056/jnm15168.

    Article  Google Scholar 

  30. William PT, John CA, Patrick DB. Neuroradiologic evaluation of sacral abnormalities in imperforate anus complex. J Pediatr Surg. 1987;22:58–61.

    Article  Google Scholar 

  31. Capitanucci ML, Rivosecchi M, Silveri M, Lucchetti MC, Mosiello G, De Gennaro M. Neurovesical dysfunction due to spinal dysraphism in anorectal anomalies. Eur J Pediatr Surg. 1996;6:159–62.

    Article  CAS  PubMed  Google Scholar 

  32. Yuan Z, Bai Y, Zhang Z, Ji S, Li Z, Wang W. Neural electrophysiological studies on the external anal sphincter in children with anorectal malformation. J Pediatr Surg. 2000;35:1052–7. https://doi.org/10.1053/jpsu.2000.7770.

    Article  CAS  PubMed  Google Scholar 

  33. Chiarioni G, Kim SM, Vantini I, Whitehead WE. Validation of the balloon evacuation test: reproducibility and agreement with findings from anorectal manometry and electromyography. Clin Gastroenterol Hepatol. 2014;12:2049–54.

    Article  PubMed  Google Scholar 

  34. Rao SS. Dyssynergic defecation and biofeedback therapy. Gastroenterol Clin N Am. 2008;37:569–86. viii. https://doi.org/10.1016/j.gtc.2008.06.011.

    Article  Google Scholar 

  35. Rao SS, Ozturk R, Laine L. Clinical utility of diagnostic tests for constipation in adults: a systematic review. Am J Gastroenterol. 2005;100:1605–15.

    Article  PubMed  Google Scholar 

  36. Palsson OS, Heymen S, Whitehead WE. Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2004;29:153–74.

    Article  PubMed  Google Scholar 

  37. Rao SS, Tuteja AK, Vellema T, et al. Dyssynergic defecation: demographics, symptoms, stool patterns, and quality of life. J Clin Gastroenterol. 2004;38:680–5.

    Article  PubMed  Google Scholar 

  38. van Meegdenburg MM, Heineman E, Broens PMA. Dyssynergic defecation may aggravate constipation: results of mostly pediatric cases with congenital anorectal malformation. Am J Surg. 2015;210:357–64.

    Article  PubMed  Google Scholar 

  39. Bjørsum-Meyer T, Christensen P, Baatrup G, Jakobsen MS, Asmussen J, QvistN. Dyssynergic patterns of defecation in constipated adolescents and young adults with anorectal malformations. Sci Rep. 2020;10(19673) https://doi.org/10.1038/s41598-020-76841-5.

  40. Iwai N, Ogita S, Kida M, Fujita Y, Majima S. A clinical and manometric correlation for assessment of postoperative continence in imperforate anus. J Pediatr Surg. 1979;14:538–43.

    Article  CAS  PubMed  Google Scholar 

  41. Iwai N, Yanagihara J, Tokiwa K, Deguchi E, Takahashi T. Results of surgical correction of anorectal malformations. A 10-30 year follow-up. Ann Surg. 1988;207:219–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Rintala RJ, Lindahl H. Is Normal bowel function possible after repair of intermediate and high anorectal malformations? J Pediatr Surg. 1995;30:491–4.

    Article  CAS  PubMed  Google Scholar 

  43. Kumar S, Ramadan SA, Gupta V, Helmy S, Debnath P, Alkholy A. Use of anorectal manometry for evaluation of postoperative results of patients with anorectal malformation: a study from Kuwait. J Pediatr Surg. 2010;45:1843–8.

    Article  PubMed  Google Scholar 

  44. Iwai N, Hashimoto K, Goto Y, Majima S. Long-term results after surgical correction of anorectal malformations. Z Kinderchir. 1984;39:35–9.

    CAS  PubMed  Google Scholar 

  45. Heikenen JB, Werlin SL, Di Lorenzo C, Hyman PE, Cocjin J, Flores AF, et al. Colonic motility in children with repaired imperforate anus. Dig Dis Sci. 1999;44:1288–92.

    Article  CAS  PubMed  Google Scholar 

  46. Molander ML, Frenckner B. Anal sphincter function after surgery for high imperforate anus—a long term follow-up investigation. Z Kinderchir. 1985;40:91–6.

    CAS  PubMed  Google Scholar 

  47. Wang Z, Hu L, Jin X, Li X, Xu L. Evaluation of postoperative anal functions using endoanal ultrasonography and anorectal manometry in children with congenital anorectal malformations. J Pediatr Surg. 2016;51:416–20.

    Article  PubMed  Google Scholar 

  48. Keshtgar AS, Athanasakos E, Clayden GS, Ward HC. Evaluation of outcome of anorectal anomaly in childhood: the role of anorectal manometry and endosonography. Pediatr Surg Int. 2008;24:885–92.

    Article  CAS  PubMed  Google Scholar 

  49. Aspirot A. Anorectal malformations. In: Faure C, Thapar N, Di Lorenzo C, editors. Pediatric neurogastroenterology. Cham: Springer; 2017. https://doi.org/10.1007/978-3-319-43268-7_29.

    Chapter  Google Scholar 

  50. Kelly JH. The clinical and radiological assessment of anal continence in childhood. Aust NZJ Surg. 1972;42:62–3.

    Article  CAS  Google Scholar 

  51. Kiesewetter WB, Chang JH. Imperforate anus: a five to thirty-year follow-up perspective. Prog Pediatr Surg. 1977;10:111–20.

    CAS  PubMed  Google Scholar 

  52. Kyrklund K, Pakarinen MP, Rintala RJ. Manometric findings in relation to functional outcomes in different types of anorectal malformations. J Pediatr Surg. 2017;52:563–8.

    Article  PubMed  Google Scholar 

  53. Kluth D, Hillen M, Lamprecht W. The principles of normal and abnormal hindgut development. J Pediatr Surg. 1995;30:1143–7.

    Article  CAS  PubMed  Google Scholar 

  54. Ruttenstock EM, Zani A, Huber-Zeyringer A, Höllwarth ME. Pre- and postoperative rectal manometric assessment of patients with anorectal malformations: should we preserve the fistula? Dis Colon Rectum. 2013;56:499–504. https://doi.org/10.1097/DCR.0b013e31826e4a38.

    Article  PubMed  Google Scholar 

  55. Rintala RJ, Lindahl HG. Posterior sagittal anorectoplasty is superior to sacroperineal sacroabdominoperineal pull-through: a long-term follow-up study in boys with high anorectal anomalies. J Pediatr Surg. 1999;34:334–7.

    Article  CAS  PubMed  Google Scholar 

  56. Júnior PFV, Martins JL, Peterlini FL. Posterior sagittal anorectoplasty in anorectal anomalies: clinical, manometric and profilometric evaluation. Sao Paulo Med J. 2007;125:163–9.

    Article  Google Scholar 

  57. Bjørsum-Meyer T, Christensen P, Jakobsen MS, Baatrup G, Qvist N. Correlation of anorectal manometry measures to severity of fecal incontinence in patients with anorectal malformations—a cross sectional study. Sci Rep. 2020;10:19673. https://doi.org/10.1038/s41598-020-76841-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI. Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg. 1994;81:463–5.

    Article  CAS  PubMed  Google Scholar 

  59. Nichols CM, Lamb EH, Ramakrishnan V. Differences in outcomes after third-versus fourth-degree perineal laceration repair: a prospective study. Am J Obstet Gynecol. 2005;193:530–4.

    Article  PubMed  Google Scholar 

  60. Reginelli A, Mandato Y, Cavaliere C, Pizza NL, Russo A, Cappabianca S, et al. Three-dimensional anal endosonography in depicting anal-canal anatomy. Radiol Med. 2012;117:759–71.

    Article  CAS  PubMed  Google Scholar 

  61. Murad Regadas SM, Regadas FS, Rodrigues LV, Holanda EC, Barreto RG, et al. The role of 3-dimensional anorectal ultrasonography in the assessment of anterior trans-sphincteric fistula. Dis Colon Rectum. 2010;53:1035–40.

    Article  PubMed  Google Scholar 

  62. Hussain SM, Stoker J, Laméris JS. Anal sphincter complex: endoanal MR imaging of normal anatomy. Radiology. 1995;197:671–7.

    Article  CAS  PubMed  Google Scholar 

  63. Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol. 2012;85:865–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Villanueva Herrero JA, Hansen MR, Bernes LA, Bobadill J. Endoanal ultrasound for anorectal diseases. In: Gastrointestinal diseases. SM Group. p. 1–23.

    Google Scholar 

  65. Albuquerque A. Endoanal ultrasonography in fecal incontinence: current and future perspectives. World J Gastrointest Endosc. 2015;10:575–81.

    Article  Google Scholar 

  66. Gosselink MP, West RL, Kuipers EJ, Hansen BE, Schouten WR. Integrity of the anal sphincters after pouch-anal anastomosis: evaluation with three-dimensional endoanal ultrasonography. Dis Colon Rectum. 2005;48:1728–35.

    Article  PubMed  Google Scholar 

  67. Nuernberg D, Saftoiu A, Barreiros AP, Burmester E, Ivan ET, Clevert DA, et al. EFSUMB recommendations for gastrointestinal ultrasound part 3: endorectal. Endoanal Perineal Ultrasound Int Open. 2019;5:E34–51.

    Article  PubMed  Google Scholar 

  68. Athanasakos EP, Ward HC, Williams NS, Scott SM. The value of anal endosonography compared with magnetic resonance imaging following the repair of anorectal malformations. Pediatr Radiol. 2003;33:183–5.

    Article  Google Scholar 

  69. Emblem R, Morkrid L, Bjornland K. Anal endosonography is useful for postoperative assessment of anorectal malformations. J Pediatr Surg. 2007;42:1549–54.

    Article  PubMed  Google Scholar 

  70. Dal Corso HM, D’Elia A, De Nardi P, Cavallari F, Favetta U, et al. Anal endosonography. A survey of equipment, technique and diagnostic criteria adopted in nine Italian centers. Tech Coloproctol. 2007;11:26–33.

    Article  CAS  PubMed  Google Scholar 

  71. Emblem R, Diseth T, Morkrid L. Anorectal anomalies: anorectal manometric function and anal endosonography in relation to functional outcome. Pediatr Surg Int. 1997;12:516–9.

    Article  CAS  PubMed  Google Scholar 

  72. Danielson J, Karlbom U, Graf W, Wester T. Persistent fecal incontinence into adulthood after repair of anorectal malformations. Int J Color Dis. 2019;34(3):551–4. https://doi.org/10.1007/s00384-018-3220-6.

    Article  Google Scholar 

  73. Danielson J, Karlbom U, Wester T, Graf W. Injectable bulking treatment of persistent fecal incontinence in adult patients after anorectal malformations. J Pediatr Surg. 2020;55:397–402.

    Article  PubMed  Google Scholar 

  74. Dewberry L, Trecartin A, Peña A, Pierre MS, Bischoff A. Systematic review: sacral nerve stimulation in the treatment of constipation and fecal incontinence in children with emphasis in anorectal malformation. Pediatr Surg Int. 2019;35:1009–12. https://doi.org/10.1007/s00383-019-04515-z.

    Article  PubMed  Google Scholar 

  75. Thomas GP, Nicholls RJ, Vaizey CJ. Sacral nerve stimulation for faecal incontinence secondary to congenital imperforate anus. Tech Coloproctol. 2013;17:227–9.

    Article  CAS  PubMed  Google Scholar 

  76. Eftaiha SM, Melich G, Pai A, Marecik SJ, Prasad LM, Park JJ. Sacral nerve stimulation in the treatment of bowel dysfunction from imperforate anus: a case report. Int J Surg Case Rep. 2016;24:115–8. https://doi.org/10.1016/j.ijscr.2016.05.018.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Danielson J, Karlbom U, Wester T, Graf W. Long-term outcome after dynamic graciloplasty for treatment of persistent fecal incontinence in patients with anorectal malformations. Eur J Pediatr Surg. 2019;29(3):276–81. https://doi.org/10.1055/s-0038-1641599.

    Article  PubMed  Google Scholar 

  78. Reddymasu SC, Singh S, Waheed S, Oropeza-Vail M, McCallum RW, Olyaee M. Comparison of anorectal manometry to endoanal ultrasound in the evaluation of fecal incontinence. Am J Med Sci. 2009;337:336–9.

    Article  PubMed  Google Scholar 

  79. Bordeianou L, Lee K, Rockwood T, Baxter N, Lowry A, Mellgren A, et al. Anal resting pressures at manometry correlate with the fecal incontinence severity index and with presence of sphincter defects on ultrasound. Dis Colon Rectum. 2018;51:1010–4.

    Article  Google Scholar 

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  1. Digestive Surgery and Endoscopy Unit, Bambino Gesù Children’s Hospital-IRCCS, Rome, Italy

    Tamara Caldaro

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  1. Pediatric Surgery Unit, IRCCS Sant’Orsola University-Hospital University of Bologna, Bologna, Italy

    Mario Lima

  2. Pediatric Surgery Unit, IRCCS Sant’Orsola University-Hospital University of Bologna, Bologna, Italy

    Giovanni Ruggeri

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Caldaro, T. (2022). Anorectal Malformations: Anorectal Manometric and Endosonographic Combined Approach. In: Lima, M., Ruggeri, G. (eds) Ano-Rectal Endosonography and Manometry in Paediatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-97668-2_8

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