PP-4 ANORECTAL MALFORMATIONS: MOTILITY STUDIES AND RESPONSE TO BIOFEEDBACK THERAPY.

BACKGROUND: Anorectal malformations (ARM) are infrequent anatomic defects with a prevalence of 1 each 5000 alive newborns. Most of the patients repaired of this illness have some degree of constipation or fecal incontinence. There are few reports about manometric studies and biofeedback treatment in patients with anorectal malformations.

OBJECTIVES: To evaluate of our population's anorectal functionality late after surgery by anorectal manometry; To study the response to diet, toilet training, and/or biofeedback.

METHODS: Anorectal manometry was done in 39 patients with ARM and 35 of them received combinated treatment of diet, toilet training and biofeedback. Age: 6 to 17 years old. Mean age: 8.05 years. Descriptive study. From april 2004 to april 2015. 14 patients had high malformations(36%), 18 had low malformations(46%) and 7 had cloaca(18%).

INCLUSION CRITERIA: children over 6 years of age with anorectal malformation operated using Peña's technique (postsagittal anorectoplasty).

EXCLUSION CRITERIA: patients with neurological disorders that do not non-compliant with study and treatment indications.

RESULTS: Average resting pressure was 28 mmHg(High level 25,5 and Low level 29,8 mmHg), range between 7 and 51 mmHg. Squeezing pressure between 29 and 120 mmHg(mean:69mmHg). Combined treatment of diet, toilet training, and biofeedback was succesfull to get total continence in 22 patients (4 cloacas, 10 high malformations and 8 low malformations), partial continence in 6(all low) and without response in 3(1 low, 1 high and 1 cloaca); 2 patients archived continence only with toilet training and 2 were lost in follow up(T.Fisher: 0,1). In high ARM 8 had positive(+) rectoanal inhibitory reflex(RAIR) and 6 negative(¬). In cloacas it was (+) in 3, (¬) in 3 and doubtful in 1. In low ARM 15(+), 2 (¬) and 1 doubtful. Reflex was obtained with 20 to 60cc of air(mean 31,36). The RRAI duration was 10 to 17 seconds(mean: 13 seconds).From 22 total continent, RAIR was (+) in 13, (¬) in 7 and hazardous in 2. All 6 partially continent had (+) RAIR; and from 3 incontinent, 2 had (+) RAIR and 1 (¬). From succesfully treated, 10 showed low resting pressures at the anal channel and 12 had normal pressures. Squeezing pressure was normal in 35 and negative in 4.

CONCLUSIONS: 1) RAIR was (+) in most of low malformations, while in high and cloacas only nearly half of them were (+). 2) RAIR and resting pressures at the anal channel were not useful to predict treatment success. 3) Malformation Height was not significant to determine patients outcome. 4) Combined dietary, toilet training and biofeedback therapy was effective for achievement of fecal continence in most of our population.