Usefulness of Manometry in Anorectal Diseases

Kim, Chang Nam; Park, Sang Kyu; Kim, Sook Young; Yu, Chang Sik; Kim, Jin Cheon

Abstract

PURPOSE: Anorectal manometry is an objective means of assessing the anorectal function through the anorectal sphincter muscles. The purpose of this study was to assess the usefulness of anorectal manometry.
METHODS
Manometric findings of 1145 patients with anorectal diseases were analyzed.
RESULTS
In hemorrhoids, the maximum resting pressure (MRP) was significantly decreased postoperatively (P<0.05), and the maximum squeezing pressure (MSP) was decreased postoperatively. The MRP was increased in hemorrhoids, internal sphincter hypertonia, and chronic anal fissure (CAF). The MRP and MSP were significantly decreased in CAF, anal fistula, and anal stricture postoperatively (P<0.05). In anal fistula, the high pressure zone length and sphincter length were significantly decreased postoperatively (P<0.05), and the vector symmetric index was decreased to 0.79 postoperatively. Fourteen of the 57 patients with fecal incontinence did not show rectoanal inhibitory reflex (RAIR). In 22 of the 25 patients were clinically suspected of congenital megacolon (CMC), unnecessary surgery was avoided with RAIR. Twelve of the 15 patients with CMC, who had undergone surgery, showed the RAIR. In patients treated by total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and familial adenomatous polyposis (FAP), the MRP and MSP were decreased postoperatively, and the sensation of fullness (SOF) was significantly decreased postoperatively (P<0.05). In patients with rectal cancer treated by low anterior resection, the MRP, MSP, SOF, and compliance were significantly decreased until 12 months postoperatively (P<0.05).
CONCLUSIONS
Manometry appears to be an important tool to evaluate anorectal function that enables adequate surgery or treatment for the most of anorectal diseases. Furthermore, it is a valuable tool in assessing functional recovery after surgeries associated with a sphincter injury.