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HK J Paediatr (New Series)
Vol 22. No. 4,
2017
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HK J Paediatr (New Series) 2017;22:204-208
Original Article
Application of Three Dimensional High Resolution Anorectal Manometry to Demonstrate Anal Sphincter Pressure Asymmetry in Children after Anorectal Surgery: A Pilot Study
PMY Tang, MWY Leung, JWS Hung, KLY Chung, CSW Liu, NSY Chao, KKW Liu Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong, China PMY Tang (鄧敏儀) FRCS(Paed Surg), FHKAM MWY Leung (梁偉業) FRCS(Paed Surg), FHKAM JWS Hung (孔詠雪) FRCS(Paed Surg), FHKAM KLY Chung (鍾立人) FRCS(Paed Surg), FHKAM Department of Surgery, United Christian Hospital, 130 Hip Wo street, Kwun Tong, Kowloon, Hong Kong, China CSW Liu (廖思維) FRCS(Paed Surg), FHKAM NSY Chao (趙式言) FRCS(Paed Surg), FHKAM KKW Liu (廖鑑榮) FHKAM Correspondence to: Dr PMY Tang Email: tangpaula@gmail.com Received March 23, 2016
Abstract Purpose: The use of anorectal manometry in the evaluation of anal sphincter function has been well established. The new three dimensional (3D) high resolution anorectal manometry (HRARM) would provide additional information regarding the symmetry of the anal sphincter pressure. Methods: We prospectively recruited 17 patients with defaecation disorders: 3 patients with idiopathic constipation, 8 patients with Hirschsprung's disease and 6 patients with anorectal malformation. 3D HRARM was performed. The resting pressure and squeeze pressure at the physiological sphincter were measured and analyzed. We define the inter-quadrant pressure asymmetry index (Δp) mathematically, Δp = (maximal pressure - minimal pressure)/maximal pressure x 100%. Results: There was an increasing inter-quadrant pressure asymmetry index (Δp) observed in the anal pressure profiles in patients with history of Soave pullthrough, myomectomy, Duhamel operation and posterior sagittal anoplasty (PSARP). The asymmetry is more pronounced in squeeze pressure in the Soave pullthrough group, and less pronounced in squeeze pressure in the myomectomy, Duhamel and PSARP group. Conclusions: The inter-quadrant pressure asymmetry index (Δp) reflects the post operative status of anal sphincter, which is influenced by the different surgical maneuvers employed in the operations. The symmetry of anal sphincter pressure might provide useful anatomical parameters in the assessment of surgical outcomes. Keyword : Anorectal malformation; Anorectal manometry; High resolution; Hirschsprung's disease; Symmetry Abstract in Chinese
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