Functional Outcomes of Patients Who Underwent Anorectal Malformation Repair Using MRI Guidance

• Published in: Journal of pediatric surgery Vol. 59; no. 6; pp. 1044 - 1049
• Main Authors: Dougherty, Danielle, Ralls, Matthew W., Plagens, Connor J., Ladino-Torres, Maria, Williams, Keyonna M., Wild, Laurie, Jarboe, Marcus D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2024
• Subjects: Anal Canal - abnormalities; Anal Canal - surgery; Anorectal malformation; Anorectal malformation functional outcomes; Anorectal malformation repair; Anorectal Malformations - surgery; Anus, Imperforate - diagnostic imaging; Anus, Imperforate - surgery; Child; Child, Preschool; Constipation - etiology; Continence; Enema - methods; Fecal Incontinence - etiology; Female; Follow-Up Studies; Humans; Infant; Laparoscopy - methods; Laxatives - administration & dosage; Laxatives - therapeutic use; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Postoperative Complications - etiology; Rectum - abnormalities; Rectum - surgery; Retrospective Studies; Surgery, Computer-Assisted - methods; Treatment Outcome; Continence; BMP; MRI; LAARP; IQR; Anorectal malformation; PSARP; BCS; PCPLC; Magnetic resonance imaging; Anorectal malformation repair; Anorectal malformation functional outcomes; ARM
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2023.12.023

Despite the initiation of minimally invasive laparoscopic techniques, the majority of patients who undergo anorectal malformation repair still experience functional bowel issues in childhood, including constipation and fecal incontinence. In this study, we evaluate the functional outcomes of a procedure in which magnetic resonance imaging guidance is used during initial laparoscopic repair to better locate the epicenter of the sphincter muscle complex and pelvic floor with the goal of more accurate placement of the neoanus and improved functional outcomes. A retrospective chart review evaluated demographic, operative, and outcome details for patients who underwent this procedure. A telephone survey was employed to determine levels of social continence using the validated Baylor Continence Scale and to determine what type of bowel management is used. Twenty-six patients were included. Median age at operation was 7 months, and median age at follow-up was 4 years old, with a range of 1–9. Bowel management regimen results revealed that 19 % (n = 5) use no bowel management regimen, 58 % (n = 15) use laxatives only, and 23 % (n = 6) use enemas. Enema use was not associated with different spine or sacral anomalies (p = 0.77). Fifteen patients (58 %) answered the Baylor Continence Scale questions and had a median score of 14. No difference was found in scores when accounting for lesion level (p = 0.43), quality of needle placement (p = 0.46), or quality of sphincter muscles (p = 0.75). Using MRI guidance in the repair of anorectal malformations shows promise in both the qualitative and quantitative functional outcomes of this complex patient population. Level III. •Many patients who undergo anorectal malformation repair still experience functional bowel issues in childhood.•Using MRI guidance in the repair of anorectal malformations, with the goal of limiting muscle injury, shows promise in improving the functional outcomes of this complex patient population.