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Levator ani asymmetry and deviation in high-type anorectal malformation evaluated by magnetic resonance imaging

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Abstract

Introduction

The levator ani (LA) complex in high-type imperforate anus (H-IA), low-type imperforate anus (L-IA), and Hirschsprung’s disease (HD) patients as controls were documented using magnetic resonance imaging (MRI) and compared for symmetry.

Materials and methods

Mean left:right LA thickness ratio (LA ratio), and deviation of the LA from the pubococcygeal line (PCL; LA angle) were calculated from thin-slice MRI images (axial 2 mm, coronal 2 mm, and sagittal 3 mm) of the puborectalis and pubococcygeus taken parallel to the PCL under sedation in H-IA (n=14), L-IA (n=16), and HD (n=9).

Results

MRI scans were performed between January 2018 and June 2021. LA were significantly thinner in H-IA (1.78±0.46 mm) compared with L-IA (2.97±0.55 mm) and controls (2.87±0.32 mm), p<0.0001. LA ratio was significantly lower in H-IA (0.71±0.15) compared with L-IA (0.93±0.04), and controls (0.91±0.06), p<0.0001. Mean LA-angle was significantly different in H-IA, 10.8° (range 6°–19°), versus L-IA and controls, both zero degrees (range 0°–5°), p<0.0001, respectively.

Conclusions

LA was confirmed to be significantly asymmetric in H-IA. Because outcome of surgical repair involving a midline incision, such as posterior sagittal anorectoplasty could be impaired, pediatric surgeons are advised to plan surgical intervention for H-IA carefully and appropriately.

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Authors and Affiliations

  1. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan

    Yuichiro Miyake, Takanori Ochi, Shogo Seo, Go Miyano, Hiroyuki Koga, Geoffrey J. Lane & Atsuyuki Yamataka

  2. Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan

    Yuki Yamashiro & Ryohei Kuwatsuru

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  1. Yuichiro Miyake
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  2. Takanori Ochi
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Correspondence to Yuichiro Miyake.

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Miyake, Y., Ochi, T., Yamashiro, Y. et al. Levator ani asymmetry and deviation in high-type anorectal malformation evaluated by magnetic resonance imaging. Pediatr Surg Int 38, 749–753 (2022). https://doi.org/10.1007/s00383-022-05104-3

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