Assessing the long term manometric outcomes in patients with previous laparoscopic anorectoplasty (LARP) and posterior sagittal anorectoplasty (PSARP).

BACKGROUND/PURPOSE: The objective of this study is to compare the long term manometric outcomes in patients with previous laparoscopic anorectoplasty (LARP) and posterior sagittal anorectoplasty (PSARP).

METHODS

This is a single-centered retrospective study and the participants were born with various types of anorectal malformation. Manometric assessment was carried out with high-resolution anorectomanometry performed as a day procedure. In addition, a seven-itemed bowel function score (BFS) was utilized to assess the functional outcomes.

RESULTS

A total of 30 patients were included in this study (PSARP=14, LARP=16) and the median follow up periods were 15.5years and 9years in the PSARP and LARP groups respectively (p=0.06). The median value of BFS was significantly lower in the PSARP group (PSARP=12.5, range: 8-18; LARP=16, range: 10-20, p=0.03). The median value of sphincteric resting pressure was 20mmHg (range: 10-50mmHg) in the PSARP group and 40mmHg (range: 10-70mmHg) in the LARP group (p=0.05). There was no significant difference in following measurements: the percentage of patient having a normal sphincteric resting pressure (PSARP vs LARP=50% vs 75%, p=0.28); the median sphincteric squeeze pressure (PSARP vs LARP=30mmHg, range: 10-100 vs 50mmHg, range: 20-140mmHg, p=0.08); the incidence of rectoanal inhibitory reflex (RAIR) (PSARP vs LARP=42.9% vs 31.3%, p=0.14) and the median value for volume of air to elicit the first anal sensation (PSARP vs LARP=30ml, range: 20-60ml vs 40ml, range: 20-80ml, p=0.18).

CONCLUSION

Anorectomanometry is a useful follow up study after anorectoplasty and majority of the patients with previous LARP could retain a normal sphincteric resting pressure during long term follow up. Comparing the two surgical approaches, patients with previous LARP could achieve a higher bowel function score as well as sphincter resting pressure in manometric assessment.

LEVEL OF EVIDENCE: Level III.