PSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARP, due to the existence of a relationship between the manometric results and the degree of fecal continence.A anorretoplastia sagital posterior (ARPSP) é o procedimento cirúrgico mais utilizado atualmente para a correção das anomalias anorretais altas e intermediárias. Existe muita controvérsia na literatura a respeito da avaliação pós-operatória desses pacientes. Baseado nesse fato, estudamos 27 casos de anomalias anorretais operados com a ARPSP do ponto de vista clínico e manométrico, com a finalidade de avaliar: 1. Continência fecal; 2. Relação entre a continência fecal e anomalias sacrais associadas; 3. Relação entre a avaliação manométrica pós-operatória e a continência fecal. Da análise dos 27 casos de anomalias anorretais altas e intermediárias, concluímos que: 1. A continência fecal foi conseguida plenamente em 48,14% dos casos, parcialmente em 25,92% dos casos, e a incontinência fecal foi observada em 25,92%; 2. A presença de incontinência fecal foi diretamente relacionada com a associação de anomalias sacrais; 3. A manometria anorretal foi extremamente útil para avaliar os pacientes operados por anomalias anorretais devido à existência de uma relação entre os resultados manométricos e o grau de continência fecal.Federal University of São Paulo PSMUNIFESP, PSMSciEL

Martins, Jose Luiz

Pinus, José

Sao Paulo Medical Journal

PSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARP, due to the existence of a relationship between the manometric results and the degree of fecal continence.A anorretoplastia sagital posterior (ARPSP) é o procedimento cirúrgico mais utilizado atualmente para a correção das anomalias anorretais altas e intermediárias. Existe muita controvérsia na literatura a respeito da avaliação pós-operatória desses pacientes. Baseado nesse fato, estudamos 27 casos de anomalias anorretais operados com a ARPSP do ponto de vista clínico e manométrico, com a finalidade de avaliar: 1. Continência fecal; 2. Relação entre a continência fecal e anomalias sacrais associadas; 3. Relação entre a avaliação manométrica pós-operatória e a continência fecal. Da análise dos 27 casos de anomalias anorretais altas e intermediárias, concluímos que: 1. A continência fecal foi conseguida plenamente em 48,14% dos casos, parcialmente em 25,92% dos casos, e a incontinência fecal foi observada em 25,92%; 2. A presença de incontinência fecal foi diretamente relacionada com a associação de anomalias sacrais; 3. A manometria anorretal foi extremamente útil para avaliar os pacientes operados por anomalias anorretais devido à existência de uma relação entre os resultados manométricos e o grau de continência fecal.Federal University of São Paulo PSMUniversidade Federal de São Paulo, EPM, São Paulo, BrazilSciEL

Martins, Jose Luiz [UNIFESP]

Pinus, José [UNIFESP]

Repositório Institucional UNIFESP

Jose Luiz Martins, Jose PinusClinical and manometric postoperative evaluation ofposterior sagital anorectoplasty (PSARP) in patients withupper and intermediate anorectal malformationsFederal University of Siio Paulo - PSM - Siio Paulo, BrazilPSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations,but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectalmalformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationshipbetween fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evalu-ation and fecal continence: From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1)fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectalmanometry is a useful test to evaluate the patients operated by PSARp' due to the existence of a relationship between the manometricresults and the degree of fecal continence.UNITERMS: Anorectal malformations, Posterior sagital anorectoplasty.INTRODUCTIONAnorectal malformations (ARMs) still present agreat challenge to the pediatric surgeon. Since thestudies of Pena and De Vries, 1 posterior sagitalanorectoplasty (PSARP), has become the main treatmentfor upper and intermediate ARMs in most pediatriccenters around the world. These authors also highlightedthe importance of sacral malformations by stating thatsacral and ARMs together lead to less favorablepostoperative results.Postoperative evaluation of patients with ARMs isvery controversial. Therefore, we evaluated clinical andmanometric results of 27 children with upper andintermediate ARMs who underwent PSARP.Address for correspondence:Jose Luiz MartinsRua dos Otonis, 131 - V. ClementinoSao Paulo/SP - Brasil - CEP 04025-000PATIENTSWe studied 27 white chi Idren with 21 upper and 6intermediate ARMs, of which 17 were male and 10 werefemale, and all of whom presented fistulas (17 urethral, 5vaginal, 5 vestibular). Ages varied from 4 to II years.These patients underwent colostomies with 2openings prior to PSAPR, anal dilations with Hegar'scandles during the postoperative period, and the closingof the colostomies. We assessed these patients clinicallyand with anorectal electromanometry in order to evaluatefecal continence, relations between fecal continence andany associated sacral malformations, and relations betweenfecal continence and electromanometry.Anorectal manometry was performed with rectal andsph incter balloons.2 We con nected the ba Iloons to press uretransducers (Dixtal) in turn connected to aMP-I 00amplifier, a video monitor, and a 3-channel register, all ofwhich were functionally constructed and modified to assessanorectal preSSlJre.3.4 All exams were done withoutMARTINS, J.L. & PINUS, J. - Clinical and manometric postoperative evaluation of posteriorsagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformationsSao Paulo Medical Journal/RPM 114(6): 1303-1308, 19961304sedation; register sensitivity was calibrated at N = 10 mm/mv with a speed of Imm/sec. ,Manometric assay was done by following these steps:I. Initial resting pressure measurement" (in mmHg).2. Study of sphincter-rectal reflexes by filling rectalballoon and observing the pressure response in thesphincter balloon. Reflexes were considered present whena clear pressure decrease in the sphincter balloon wasobserved, and considered absent when this was notobserved.3. The pressure response of the sphincter balloonduring coughing was measured (in mmHg).4. The pressure response of the sphincter balloonduring voluntary sphincter contraction was measured (inmmHg).5. The time of sustained, voluntary contraction wasmeasured (in seconds). '6. The pressure response to stimulation of perianalskin with a needle was measured (in mmHg).7. The pressure response to patient's crying wasmeasured (in mmHg).8. The anal pressure was registered after theintroduction of sphincter balloon into the upper rectumand constant withdrawal at 1 cm every 5 seconds (simplepressure curve).9. The anal pressure curb was registered duringwithdrawal of sphincter balloon while patient was eithercoughing, crying, or voluntarily contracting the anus(stimulated pressure curve).5Based upon these findings, the children wereclassified into the following three groups:I. Continent - those who defecated once or twice aday, with no soiling, no fecal or anal alterations, and withgood upper and lower rectal contraction duringexamination.2. Partially continent - those who defecated three tofive times a day, with normal feces and frequent soiling,who presented rectal prolapse, and with moderate upperor lower contraction during rectal examination.3. Incontinent - children who defecated more thanfive times a day, with liquid feces and a constant and totalfecal loss, an anus with a large opening, rectal prolapse,and a visible loss of feces and who presented light or noupper or lower contraction during examination.Statistical analysis was done with chi-squared testsfor 2XN tables to compare the continent, partiallycontinent, and inco~tinent groups according to the above-men'tioned characteristics. Analyses of variance usingFriendman's rank test were used to compare each patient's,initial pressures, voluntary contraction, and perianalTable 1Relation between fecal continence and sacral,malformationsWith Sacral Without Sacral TotalMalformations MalformationsContinent 1 12 13Partially 3 4 7continentIncontinent 6 7stimulation, and the three groups; in case of significantdifferences, multiple comparison tests were alsoperformed.6 We used Kruskall- Wallis' test to comparepatients of all three groups in relation to pressure values,which were completed by multiple comparison tests.RESULTS1. Fecal continenceThirteen of 27 cases submitted to PSARP presentedfecal continence, 7 cases presented partial continence, and7 incontinence.2. Relation between fecal continence and sacralmalformationsThis relation is depicted in Table I.3. Relation between fecal continence and manometric assaysThis relation is show in Table 2All patients in the three groups presented an absenceof the sphincter-rectal reflex.Statistical analysis of the data showed that initialpressure, pressure after coughing, pressure after voluntarycontractio'n, pressure after perianal stimulation, andpressure after crying were significantly higher in continentpatients. There were no statistically significant differenceswhen studying sustained contractions.Analysis of the shapes of the normal and stimulatedpressure curves showed that the percentage of normalcurves in incontinent patients was significantly lower thanin the other patients. Pressure levels showed much higherrates of normality in continent patients when compared tosao Paulo Medical Journal/RPM 114(6): 1303-1308, 1996 MARTINS, J.L. & PINUS, J. - Clinical and manometric postoperative evaluation of posteriorsagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations1305Table 2Relation between fecal continence and manometric evaluationNo. of IP* Cough VC* SVC** PS* CRY*Continent patients13 13.92 23.25 22.85 8.75 16.42 14.2No. of IP* Cough VC* SVC** PS* CRY*Partially continentpatients7 10.86 16.67 17.29 9.83 12.86 22No. of IP* Cough VC* SVC** PS* CRY*Incontinent patients7 6.57 6.67 9.86 5.5 08 10.3IP = Initial pressure; VC = Voluntary contraction; SVC = Sustained voluntary contraction; PS = Perianal stimulation* = mmHg; ** = secondsincontinent and partially continent patients. Although thefrequency of contractions could not be statisticallyanalyzed, a higher incidence of contractions in continentpatients was suggested.LS.F~ . A.A.R. Alla . f.R.t: .• P.O. dr A.k.P.~.J'., .,.t .t-- •.It. ,~Figure 1 - Manometry of continent patient.Figures I, 2, and 3 show manometric readings froma continent, a partially continent, and an incontinentpatient, respectively.Schnaufer et £11.7 demonstrated the applicabi lity ofanorectal manometry in the postoperative evaluation ofanorectal malformations. Several authorsX-'4 have alreadyreported anorectal manometry in this kind of evaluation.Analysis of the initial pressure of our patients incomparison to fecal continence showed similar results toseveral other reports; there are pressure ranges definedfor continent, partially continent, and incontinent patients,with a direct relation between initial pressure and fecalcontinence as mentioned by Haberkorn et £11.15 and Iwayet £11."Mischalany et al.1fi reported during the "FirstInternational Symposium of Anorectal Manometry" thatit is difficult to establish a pattern in anorectal manometryresults, as many types of equipment and different methodsof evaluation are used around the world. From 1987 to1995 we used electromanometry with the balloon methodon 1,153 patients,17 and si nce 1995 we have been usi ngcomputerized anorectal manometry. IXThe absence of the sphincter-rectal reflex among ourpatients was expected, as they presented upper orintermediate anorectal malformations in which there iseither a low-functioning or absent sphincter. Even amonglower malformations, in which internal sphincter fibersare rudimentary, II) the reflex is present in only 70 percentof the cases.20Pressu res obtai ned wi th cou gh ing, vo lu ntarycontraction, crying, perianal stimulation, and the time ofsustained contraction allowed us to evaluated striatedmuscles of the sphincter complex.MARTINS, J.L. & PINUS, J. - Clinical and manometric postoperative evaluation of posteriorsagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformationssao Paulo Medical Journal/RPM 114(6): 1303-1308, 19961306Table 3Relation between fecal continence and manometricevaluation of simple (SPC) and stimulated (StPC)pressure curvesC = Continent; P = Partially continent; I = IncontinentSPC = Simple pressure curve; StPC = Stimulatedpressure curve; PL = Pressure level; Ctrc = ContractionsA = Abnormal; N = Normal; L = Low; F = Frequent;S = SeldomPressures upon coughing give us an idea of thereflexive resistance of the upper part of the anorectalsphincter complex to a sudden rise in abdominal pressure.According to Scharli and Kiesewetter,21 the receptors thattrigger reflex contractions may be situated in the puborectalmuscle.Pressure during voluntary contraction is of majorimportance in manometric evaluation, since it reflects the Figure 2 - Manometry of partially continent patient.patient's capacity to halt defecation with the action of thestriated muscles of the sphincter complex, by the closingthe lower rectum using the external sphincter, and byelevating and tightening the upper rectum using thepuborectal muscle.Perianal stimu lation triggers the contraction ofstriated muscles according to the degree of stimulation,integrity of the muscle, and innervation. Continence isbetter in patients with a good response to this stimulation.'4Pressures after crying allow good sphincterevaluation in small children due to wave contractions thatare triggered by tightening reflexes.Some comments should be made regarding pressurecurves. Ahran et alY started using pressure curves toevaluate the extension and pressure of the anal canal inoperated anorectal malformations, publishing their studyin 1976.10 Gil-Vernet et al,22 highlighted the importanceof pressure profiles done with progressive withdrawal ofcatheters from the rectum to the anus at a constant speed,obtaining a pressure curve usecl to evaluate the treatmentof fecal incontinence in children who underwent surgicalcorrection of anorectal 'malformations.SSSSFFSSFFFFFFSFFFFFFStPCShape PL Ctrc.A L A LN N N NN N N NN N N FN N N NN L N LN N N NN N N NN N N NN N N NN N N NN N N NN L N LN L N LN N N NN N N NN L N LN L N LN L N LA L A LA L A LA L A LN L N LA L A LN L N LA L A LSPCShape PLN FecalCont.1 C2 C.5 C8 C12 C14 C17 C18 C21 C22 C25 C27 C7 P9 P10 P16 P20 P23 P24 P3 I4 I6 I11 I13 I15 I19 Isao Paulo Medical Journal/RPM 114(6): 1303-1308, 1996 MARTINS, J.L. & PINUS, J. - Clinical and manometric postoperative evaluation of posteriorsagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations1307,.. ,. .~ __ ~.~.~~ ( eLFigure 3 - Manometry of incontinent patient.The initial part. of the simple pressure curves showthe repercussipn of the anal levator muscle, especially ofthe puborectal portion; the distal portion shows the pressurein the external sphincter of the anus. A stimulated curve isobtained by asking the patient to cough or to contract theanus voluntarily; moreover, this can also be obtained duringcrying. Total or partial contractions observed in the curveduring withdrawal of the catheter at constant speeddemonstrate which regions are capable of contracting.PSARP is used throughout the world for primarytreatment of upper and intermediate ARMs. However, itis a difficult technique which requires from the surgeon aconsummate knowledge of anorectal and urogenitalanatomy, and also knowledge of anorectal functions foran adequate procedure and postoperative follow-upYThe surgeon must follow-up patients for many yearsby evaluating fecal continence and directing "biofeedback"physiotherapy24.25 treating the patient comprehensi vely,including psychiatrically.As Smith affirms,26 each generation of pediatricsurgeons brings new techniques and tactics to ARMtreatment, which despite all the enthusiasm and hope thesemay generate, should be thoroughly and critically tested.CONCLUSIONSI. PSARP maintained fecal continence in 48.14percent of the cases and maintained partial continence in25.92 percent of the cases.2. Fecal incontinence was associated directly withsacral malformations.3. Anorectal manometry was useful in evaluatingpatients, as the degree of conti nence corresponded tomanometric findings.RESUMOA anorretoplastia sagital posterior (ARPSP) eo procedimento cirurgico mais utilizado atualmente para a correr;ao das anomaliasanorretais altas e intermediarias. Existe muita controversia na Iiteratura a respeito da avaliar;ao p6s-operat6ria desses pacientes.Baseado nesse fato, estudamos 27 casos de anomalias anorretais operados com a ARPSP do ponto de vista clinico emanometrico, com a finalidade de avaliar: 1. Continencia fecal; 2. Relayao entre a continencia fecal e anomalias sacraisassociadas; 3. Relayao entre a avaliayao manometrica p6s-operat6ria e a continencia fecal. Da analise dos 27 casos deanomalias anorretais altas e intermediarias, concluimos que: 1. A continencia fecal foi conseguida plenamente em 48,14% doscasos, parcialmente em 25,92% dos casos, e a incontinencia fecal foi observada em 25,92%; 2. A presenc;;ade incontinenciafecal foi diretamente relacionada com a associac;ao de anomalias sacrais; 3. A manomet ria anorretal foi extremamente LJtilpara avaliar os pacientes operados por anomalias anorretais devido a existencia de uma relayao entre os resultadosmanometricos e 0 grau de continencia fecal.MARTINS, J.L. & PINUS, J. - Clinical and manometric postoperative evaluation of posteriorsagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformationsSao Paulo Medical Journal/RPM 114(6): 1303-1308, 19961308REFERENCESI. Pefia A, De Vries SPA. Posterior sagitalanorectoplasty:important technical considerations and newapplications. J Pediatr Surg 1982; 17(6):796-811.2. Martins JL, Pinus JQ, Pinus J. Manometria anorretal. In:Penna, FJ, Wheba J, Fagundes Neto D, eds.Gastroenterologia Pediatrica, lSI ed. Ed. Rio de Janeiro:Medi Si, 1983:641-50.3. Martins JL, Pinus JQ, Pinus J. Manometria anorretal. In:Penna, FJ, Wheba J, Fagundes Neto D, eds. GastroenterologiaPediatrica.2nd ed. Ed. Rio de Janeiro: Medsi, 1991 :805-11.4. Martins JL, Pinus JQ, Pinus J. Nova aparelhagem paramanometria anoretal de tecnologia brasileira. Rev Paul Ped1990;8(30): 108-10.5. Martins JL. Avaliac;ao pos-operatoria de crianc;as portadorasde anomalias anorretais, submetidas a correc;ao cirurgica pelaanorretoplastia sagital posterior. Tese de Docencia Livre,Escola Paulista de Medicina, 1993: III.6. Siegel S. Estadistica no parametrica. Mexicol: Ed. Trillas,1975:346.7. Schnaufer L, Talber1 JL, Haller A, Reid NCRW, Tobon F,Schuster MM. Differential sphincteric studies in diagnosisof ano-rectal disorders of childhood. J Pediatr Surg 1967;2(6):538-43.8. Eisner M. Functional examination of rectum and anus innormals, in disturbances of continence and defecation andin congenital malformations. Scand J Gastroentero1972;7:305-08.9. Ahran P, Faverdin C, ThouvenotJ. Anorectal motility in sickchildren. Scand J Gastroenterol 1972;7:309-34.10. Ahran P, Faverdin C, Devroede G, Dubois F, Coupris L,Pellerin D. Manometric assessment of continence aftersurgery for imperforate anus. J Pediatr Surg1976; II (2): 157-66.II. Iwai N, Ogita S, Kida M, Fugita Y, Magima S. A clinical andmanometric correlation for assessment of postoperativecontinence in imperforate anus. J Pediatr Surg1979; 14(5):538-43.12. Nagasaki A, Ikeda K, Hayashida Y, Slimitomo K, SameshimaS. Assessment of bowel control with anorectal manometryafter surgery for anorectal malformation. J ap J Surg1983; 14(3):229-34.13. Gil- Vernet Hughet JM, Bardji Pascual C, Boix-Ochoa .1.Dtilidad clinica de la manometria anon'ectal en la edaclpe~iatrica. An Esp Pediatr 1985;22(4):299-30514. Holschneider AM, Freeman NY. Anatomy and function ofthe normal rectum and anus. In: Stephens, FD, Smith, ED,eds. Anorectal Malformations in Children: update 1988. Bir1hDefects: Original article series, 1988;24(4): 125-54.15. Haberkorn S, Crispin A, Nixon HH. Assessment of fecalincontinence by means of manometry ancI defecogram . .TPediatr Surg 1974;9:43-7.16. Mischalany H, Suzuki H, Yokoyama J. Report on the FirstInternational Symposium of Anorectal Manometry . .TPediatSurg 1989; 24(4):356-59.17. Martins JL, Pinus J. Anorectal manometry in the childassessment of 1,153 examinations performed from /987 to1995. Rev Hosp S Paulo-Esc Paul Med 1995:6(3/4 ):80~2.18. Martins JL, Pinus J. Computerized anorectal manometry inthe pediatric patient. Initial experience. Rev Hosp S Paulo-Esc Paul Med 1995:6(3/4):83-6.19. Stephens FD, Smith ED. Anorectal malformations inchildren. Chicago: Year Book Medical Publishers, 1971.20. Holschneider AM. Treatment and functional resu Its ofanorectal continence in children with imperforate anus. ActaChiI' Belg 1983;83: 191-204.21.Scharly AF, Kiesewetter WR. Imperforate anus:anorectosigmoid pressure studies as a quantitativeevolution of postoperative continence . .T Pediatr Surg1969;4:694-704.22. Gil- Vernet Hughet JM, Sanchis LF, Marhuenda C, GimenezAI. Incontinencia de feces derivada de la atresia rectal. CirPed 1988; 1(2):69-84.23. Martins JL. Complicac;oes no tratamento das anomaliasanorretais. In: Margarido NF, Saad R., Cecconello I, MartinsJL, Soares LA, eds. Complicac;oes em Cirurgia. Ist Ed. RobeLivraria Ed., 1992:297-313.24. Olness K, Mc Pari and FA, Pipper J. Biofeedback: a newmodality in the management of children with fecal soiling . .TPediatr 1980;96(3):505-9.25. Gil-Vernet Hughet JM, Perez J, Broto .1,Casasa, .TM, Boix-Ochoa J. Dtilidad y evaluacion del biofeedback postanorrectoplastia sagital posterior. Cir Ped 1990;3(3): 130-5.26. Smith ED. The bath water needs changing, but don't throwout the baby: an overview of anorectal anomalies . .TPediatrSurg 1987;22(4):335-48.Sao Paulo Medical Journal/RPM 114(6): 1303-1308, 1996 MARTINS, J.L. & PINUS, J .• Clinical and manometric postoperative evaluation of posteriorsagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations

Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations

A anorretoplastia sagital posterior (ARPSP) é o procedimento cirúrgico mais utilizado atualmente para a correção das anomalias anorretais altas e intermediárias. Existe muita controvérsia na literatura a respeito da avaliação pós-operatória desses pacientes. Baseado nesse fato, estudamos 27 casos de anomalias anorretais operados com a ARPSP do ponto de vista clínico e manométrico, com a finalidade de avaliar: 1. Continência fecal; 2. Relação entre a continência fecal e anomalias sacrais associadas; 3. Relação entre a avaliação manométrica pós-operatória e a continência fecal. Da análise dos 27 casos de anomalias anorretais altas e intermediárias, concluímos que: 1. A continência fecal foi conseguida plenamente em 48,14% dos casos, parcialmente em 25,92% dos casos, e a incontinência fecal foi observada em 25,92%; 2. A presença de incontinência fecal foi diretamente relacionada com a associação de anomalias sacrais; 3. A manometria anorretal foi extremamente útil para avaliar os pacientes operados por anomalias anorretais devido à existência de uma relação entre os resultados manométricos e o grau de continência fecal.PSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARP, due to the existence of a relationship between the manometric results and the degree of fecal continence.Federal University of São Paulo PSMUniversidade Federal de São Paulo, EPM, São Paulo, BrazilSciEL

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Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations

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