Post-Operative Anorectal Manometry in Children following Anorectal Malformation Repair: A Systematic Review

Hannah M E Evans-Barns; Melissa Y Tien; Misel Trajanovska; Mark Safe; John M Hutson; Phil G Dinning; Sebastian K King

doi:10.3390/jcm12072543

Post-Operative Anorectal Manometry in Children following Anorectal Malformation Repair: A Systematic Review

J Clin Med. 2023 Mar 28;12(7):2543. doi: 10.3390/jcm12072543.

Authors

Hannah M E Evans-Barns^{1

2

3}, Melissa Y Tien³, Misel Trajanovska^{1

2

3}, Mark Safe⁴, John M Hutson^{2

3

5}, Phil G Dinning⁶, Sebastian K King^{1

2

3}

Affiliations

¹ Department of Paediatric Surgery, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
² Surgical Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC 3052, Australia.
³ Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia.
⁴ Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
⁵ Department of Urology, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
⁶ Department of Surgery, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, SA 5042, Australia.

Abstract

Despite surgical correction, children with anorectal malformations may experience long-term bowel dysfunction, including fecal incontinence and/or disorders of evacuation. Anorectal manometry is the most widely used test of anorectal function. Although considerable attention has been devoted to its application in the anorectal malformation cohort, there have been few attempts to consolidate the findings obtained. This systematic review aimed to (1) synthesize and evaluate the existing data regarding anorectal manometry results in children following anorectal malformation repair, and (2) evaluate the manometry protocols utilized, including equipment, assessment approach, and interpretation. We reviewed four databases (Embase, MEDLINE, the Cochrane Library, and PubMed) for relevant articles published between 1 January 1985 and 10 March 2022. Studies reporting post-operative anorectal manometry in children (<18 years) following anorectal malformation repair were evaluated for eligibility. Sixty-three studies were eligible for inclusion. Of the combined total cohort of 2155 patients, anorectal manometry results were reported for 1755 children following repair of anorectal malformations. Reduced resting pressure was consistently identified in children with anorectal malformations, particularly in those with more complex malformation types and/or fecal incontinence. Significant variability was identified in relation to manometry equipment, protocols, and interpretation. Few studies provided adequate cohort medical characteristics to facilitate interpretation of anorectal manometry findings within the context of the broader continence mechanism. This review highlights a widespread lack of standardization in the anorectal manometry procedure used to assess anorectal function in children following anorectal malformation repair. Consequently, interpretation and comparison of findings, both within and between institutions, is exceedingly challenging, if not impossible. Standardized manometry protocols, accompanied by a consistent approach to analysis, including definitions of normality and abnormality, are essential to enhance the comparability and clinical relevance of results.

Keywords: anorectal malformation; anorectum; gastrointestinal motility; high-resolution manometry; manometry.

Publication types

Review

Grants and funding

There was no funding for this systematic review. King is generously supported in his role as an Academic Paediatric Surgeon by The Royal Children’s Hospital Foundation. Evans-Barns is supported by an Australian Government Research Training Program (RTP) Scholarship, the Murdoch Children’s Research Institute Professor David Danks Scholarship, and a One in 5000 Foundation Research Award. None of the authors have any financial relationships relevant to this article to disclose.