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 outwith 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 15.5 years and 9 years 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 20 mmHg (range: 10-50 mmHg) in the PSARP group and 40 mmHg (range: 10-70 mmHg) 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 = 30 mmHg, range: 10-100 vs 50 mmHg, range: 20-140 mmHg, 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 = 30 ml, range: 20-60 ml vs 40 ml, range: 20-80 ml, 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. (c) 2017 Elsevier Inc. All rights reserved.