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

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). 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. 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). 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 III.