ANORECTAL ANOMALIES - ANORECTAL MANOMETRIC FUNCTION AND ANAL ENDOSONOGRAPHY IN RELATION TO FUNCTIONAL OUTCOME

To assess the relation between continence and the manometric and endos onographic state of the anorectal segment after surgery for anorectal anomalies (ARA). 33 adolescents operated upon for ARA and 14 controls were examined, Seventeen patients had low and 16 intermediate or high ARA, Fecal continence was recorded, and anal canal manometry was perfo rmed by microtransducer. The sphincter muscle complex and its relation to the anal opening was visualized by anal endosonography (ES). Ten p atients had perfect continence, 10 had staining, and 13 had soiling. T he anal canal resting and squeeze pressures were significantly differe nt in all three groups, and continence function was significantly corr elated to anal canal pressures, By anal ES, the internal (IAS) and the external anal sphincters (EAS) were identified with various amounts o f scar tissue in all patients. In patients with high or intermediate a nomalies the IAS was missing in the lower part of the anal canal, and abundant scar tissue was identified in the EAS in all patients, In pat ients with good continence function, the EAS was better preserved than in patients with major incontinence. The position of the anus in the EAS muscle complex was assessed, and varying degrees of eccentrically placed anal canals were identified. Continence function after surgery for ARA is thus correlated to anal canal pressures and ES images, ES, which is painless and suitable for use in children, is a valuable tool for assessing perianal structures, and the findings may serve as a he lpful guide for corrective surgery.