A low-cost pen-type neuromuscular electrical stimulator for intraoperative muscle complex localization in anorectal malformation surgery.

Accurate placement of the neo-anus within the sphincter complex is critical for continence in anorectal malformation (ARM) surgery. Intraoperative localization may be difficult, and dedicated stimulators are not always available. We describe the modification and clinical use of a low-cost pen-type neuromuscular electrical stimulator for intraoperative muscle complex localization, with successful localization achieved in all patients, enabling precise neo-anal placement without device-related complications or significant increase in operative time.