High and Intermediate Imperforate Anus: Functional Results and Postoperative Manometric Assessment

Abstract

Between 1983 and 1989, 21 patients with high (12) and intermediate (9) imperforate anus were operated on according to the author's procedure. The anatomical results are satisfactory (20/21). The records of the clinical and paraclinical assessments of 13 of these patients with a follow-up of at least 5 years, is reported. The patient history demonstrates that 12 out of 13 are clean at night, with 1 to 3 bowel movements during the day. The intermediate forms have no accidental defecation and almost no soiling. Conversely, the high forms often soil but usually do not wear thick protections. Criteria of successful reconstruction as rectal examination, defecogram, CT scan or MRI, yield limited data but no formal conclusions. Manometric studies provide a better understanding of the bowel function after pull-through procedures, by studying the rectoanal inhibitory reflex threshold (RAIRT), the maximal anal resting closure (MARCP), the conscious rectal sensitivity threshold (CRST) and the maximal rectal compliance (MRC). Technical aspects of these recordings are detailed. Manometric recording from 13 of these 21 patients show that RAIRT is present in 3 out of 6 intermediate forms and 3 out of 7 high forms. CRST is normal in all the cases except 1. MARCP was normal in 5 out of 6 intermediate lesions and 5 out of 7 high lesions. MRC is good in 5 intermediate forms and 3 high forms.(ABSTRACT TRUNCATED AT 250 WORDS)