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Late Clinical Outcome and the InternalAnal Sphincter of the Patients with High Type Anorectal Malformation (Abstract)

T. Kuroda, M. Saeki,
Tokyo, Japan



Background: The purpose of this study is to investigate the age-related improvement of defecation function in high type anorectal malformation in relation to the assessment of the internal anal sphincter.

Material and Methods: The function of defecation was studied every 5 years up to 25 years postoperatively according to the scoring system by Japanese Study Group of Anorectal Anomalies in forty-three patients operated for recto-urethral fistula; 13 operated with sacro-perineal procedure and 30 operated with endorectal pull-through (ERPT) procedures. The internal anal sphincter was assessed by anorectal manometry and histology, and the results were analyzed with the clinical outcome.

Results: The defecation scores of the sacro-perineal cases exceeded those of ERPT cases at all age groups; the averaged total score was 6.0 in the sacro-perineal cases vs. 2.1 for Rehbein’s and 3.6 in Kiesewetter-Rehbein’s cases at 5 years old, 6.5 vs. 4.1 and 4.2 at 10 years old, and 7.0 vs. 5.5 and 5.7 at 15 years old. The anorectal reflex was seen in 6 of 9 sacro-perineal cases examined, whereas seen in none of 7 Rehbein’s cases examined. Histologically, the well-developed and thickened internal circular muscle at the rectal end was found only in 28.8% of the cases, whereas discontinuation and hypoplasty of the muscle were seen in most of the cases examined.

Conclusions: The present results indicate that the internal sphincter muscle at the rectal end may be histologically maldeveloped in high type anorectal malformations; however, they can potentially develop after transplanted and contribute to the improvement of passive continence in the late post-operative period.

Key words: High type anorectal malformation, internal anal sphincter, sacroperineal anoplasty


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