Significance of searching for ganglia in the terminal rectum/fistula of complex anorectal malformations: Related to defecation function

Wei Feng; Huaqi Mu; Minmin Chen; Jin Zhu; Chenzhu Xiang; Linxiao Fan; Jinping Hou; Xiaohong Die; Yi Wang

doi:10.3389/fped.2023.1124647

Significance of searching for ganglia in the terminal rectum/fistula of complex anorectal malformations: Related to defecation function

Front Pediatr. 2023 Feb 27:11:1124647. doi: 10.3389/fped.2023.1124647. eCollection 2023.

Authors

Wei Feng¹, Huaqi Mu¹, Minmin Chen¹, Jin Zhu², Chenzhu Xiang¹, Linxiao Fan¹, Jinping Hou¹, Xiaohong Die¹, Yi Wang¹

Affiliations

¹ Department of General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
² Department of Pathology, Children's Hospital of Chongqing Medical University, Chongqing, China.

Abstract

Background: The need to search for ganglia in the terminal rectum/fistula of complex anorectal malformations (ARMs) remains controversial. This study aims to evaluate the relationship between ganglia absence in the terminal rectum/fistula and defecation function after anoplasty.

Methods: A retrospective review of patients who received anoplasty for treating male imperforate anus with rectobulbar (RB)/rectoprostatic (RP) fistulas at a tertiary pediatric hospital was conducted with registered demographic data, imaging study results, and information on the terminal rectum/fistula specimen (excision extension and pathological findings). According to the pathological findings, patients were divided into Groups 1 (ganglia absence) and 2 (ganglia presence). Furthermore, the postoperative defecation function was evaluated using various rating scale questionnaires. Statistical analysis was performed using SPSS 22.0.

Results: Of the 62 patients, 18 (29.0%) showed ganglia absence in the terminal rectum/fistula. By analyzing the imaging data, spinal anomalies and spinal cord anomalies were found in 30.6% (19/62) and 56.5% (35/62) of patients, respectively. Baseline information was comparable between Groups 1 and 2 (P > 0.05). For defecation function, there were no significant differences in Kelly scores between the two groups (4.0 ± 0.8 vs. 4.4 ± 1.1, P = 0.177), while Krickenbeck (3.7 ± 1.8 vs. 5.2 ± 1.4) and Rintala (13.7 ± 3.6 vs. 16.0 ± 2.7) scores in Group 1 were significantly lower than those in Group 2 (both P < 0.05). The overall incidence of constipation was 50% (31/62), being higher for Group 1 than Group 2 (77.5% vs. 38.6%, P = 0.002). The area under the curve of ganglia absence for predicting constipation was 0.696, with 77.8% sensitivity and 61.4% specificity.

Conclusion: Ganglia absence in the terminal rectum/fistula of male imperforate anus with RB/RP fistulas is associated with constipation after anoplasty, but it has limited predictive value for postoperative constipation. It is necessary to search for ganglia in the terminal rectum/fistula, both intraoperatively and postoperatively.

Keywords: anorectal malformation; constipation; defecation function; enteric nervous system; ganglia.

Grants and funding

This study was supported by the Program for Youth Innovation in Future Medicine, Chongqing Medical University (No. W0125).