{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:11:18Z","timestamp":1760058678617,"version":"build-2065373602"},"reference-count":17,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Distinguishing between the anatomical variant of an anterior anus and mild forms of imperforate anus with rectoperineal fistula often requires inspection, calibration, and, in uncertain cases, electrical stimulation (ES) under general anesthesia. Anorectal manometry (AM), despite its ability to assess sphincter configuration and function, is rarely reported as a diagnostic tool. This study evaluated the utility of AM in such cases. Methods: A retrospective analysis of AM and clinical data from 38 patients (35 female, 3 male) with suspected anterior anus was conducted from October 2009 to September 2021. Water-perfused catheter probes with eight radial channels were used to perform pull-through maneuvers. Sphincter locations were identified through vector reconstruction, and pressure ratios of the anterior part to the circumference were recorded. Results were compared to clinical data, including ES findings. Statistical significance was assessed using Mann\u2013Whitney U and Chi-Square tests. Results: Following AM, ES was unnecessary in 25 patients. Of the remaining patients, 83% showed abnormal sphincter configurations on ES, and seven underwent anoplasty. Patients with abnormal sphincter complexes demonstrated significantly lower mean anterior pressures (61.2 mmHg vs. 136.4 mmHg, U = 336.5, p = 0.001) and a trend toward lower anterior-to-circumferential pressure ratios (mean 0.42 vs. 0.85, U = 613, p = 0.270). Constipation was also more frequent in this group (X2(1,N = 38) = 4.1, p = 0.044). Average anterior pressures &lt; 75 mmHg and ratios &lt; 0.7 indicated an anus outside the sphincter complex (sensitivity 80%, specificity 90%). Conclusions: AM proves valuable for evaluating ambiguous anterior anus cases, potentially reducing reliance on ES under general anesthesia. 3D high-resolution AM may further increase diagnostic accuracy.<\/jats:p>","DOI":"10.3390\/diagnostics15091078","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T06:18:02Z","timestamp":1745475482000},"page":"1078","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Manometric Evaluation of the Sphincter Complex in Anterior Anus and Mild Anorectal Malformations\u2014An Important Diagnostic Tool"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6111-9916","authenticated-orcid":false,"given":"Jonathan","family":"Hencke","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Kriegsbergstrasse 62, 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3293-2879","authenticated-orcid":false,"given":"Raphael","family":"Staubach","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Kriegsbergstrasse 62, 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4788-3181","authenticated-orcid":false,"given":"Steffan","family":"Loff","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Olgahospital, Klinikum Stuttgart, Kriegsbergstrasse 62, 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"doi-asserted-by":"crossref","unstructured":"Amerstorfer, E.E., Schmiedeke, E., Samuk, I., Sloots, C.E.J., van Rooij, I.A.L.M., Jenetzky, E., and Midrio, P. (2022). Clinical Differentiation between a Normal Anus, Anterior Anus, Congenital Anal Stenosis, and Perineal Fistula: Definitions and Consequences\u2014The ARM-Net Consortium Consensus. Children, 9.","key":"ref_1","DOI":"10.3390\/children9060831"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1007\/s00383-010-2641-2","article-title":"Delayed presentation of anorectal malformations: The possible associated morbidity and mortality","volume":"26","author":"Eltayeb","year":"2010","journal-title":"Pediatr. Surg. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1542\/peds.73.2.216","article-title":"Determination of Anterior Displacement of the Anus in Newborn Infants and Children","volume":"73","author":"Reisner","year":"1984","journal-title":"Pediatrics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1055\/s-2007-963454","article-title":"Transperineal sonography of the anal sphincter complex in neonates and infants: Differentiation of anteriorly displaced anus from low-type imperforate anus with perineal fistula","volume":"29","author":"Haber","year":"2008","journal-title":"Ultraschall. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s00383-008-2181-1","article-title":"Evaluation of outcome of anorectal anomaly in childhood: The role of anorectal manometry and endosonography","volume":"24","author":"Keshtgar","year":"2008","journal-title":"Pediatr. Surg. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s00383-007-2052-1","article-title":"Magnetic resonance imaging in anterior ectopic anus","volume":"24","author":"Thambidorai","year":"2008","journal-title":"Pediatr. Surg. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s003830050003","article-title":"A computerised vector manometry study of the so-called ectopic anus","volume":"16","author":"Schuster","year":"2000","journal-title":"Pediatr. Surg. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"546","DOI":"10.14309\/ajg.0000000000002121","article-title":"Diagnosing Mild Forms of Anorectal Malformation With Anorectal Manometry: A Prospective Study","volume":"118","author":"Gerritsen","year":"2023","journal-title":"Am. J. Gastroenterol."},{"doi-asserted-by":"crossref","unstructured":"Evans-Barns, H.M.E., Tien, M.Y., Trajanovska, M., Safe, M., Hutson, J.M., Dinning, P.G., and King, S.K. (2023). Post-Operative Anorectal Manometry in Children following Anorectal Malformation Repair: A Systematic Review. J. Clin. Med., 12.","key":"ref_9","DOI":"10.3390\/jcm12072543"},{"key":"ref_10","first-page":"811","article-title":"Functional Evaluation of Ectopic Anus and Its Surgical Consequences","volume":"128","author":"Kerremans","year":"1974","journal-title":"Am. J. Dis. Child."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/DCR.0b013e31826e4a38","article-title":"Pre- and Postoperative Rectal Manometric Assessment of Patients with Anorectal Malformations: Should We Preserve the Fistula?","volume":"56","author":"Ruttenstock","year":"2013","journal-title":"Dis. Colon. Rectum."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1111\/codi.12397","article-title":"Water-perfused manometry vs three-dimensional high-resolution manometry: A comparative study on a large patient population with anorectal disorders","volume":"15","author":"Vitton","year":"2013","journal-title":"Color. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/S0022-3468(78)80315-7","article-title":"Constipation caused by anterior location of the anus and its surgical correction","volume":"13","author":"Hendren","year":"1978","journal-title":"J. Pediatr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1016\/j.jpedsurg.2014.09.074","article-title":"Bowel function and lower urinary tract symptoms in females with anterior anus treated conservatively: Controlled outcomes into adulthood","volume":"50","author":"Kyrklund","year":"2015","journal-title":"J. Pediatr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1016\/j.jpedsurg.2021.04.003","article-title":"Conservative management of anterior located anus: A medium-long term follow up","volume":"56","author":"Duci","year":"2021","journal-title":"J. Pediatr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1007\/s00383-010-2697-z","article-title":"Management and outcome of low anorectal malformations","volume":"26","author":"Pakarinen","year":"2010","journal-title":"Pediatr. Surg. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1007\/s00383-006-1789-2","article-title":"Functional outcome in correction of perineal fistula in boys with anoplasty versus posterior sagittal anorectoplasty","volume":"22","author":"Pakarinen","year":"2006","journal-title":"Pediatr. Surg. Int."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/9\/1078\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:20:32Z","timestamp":1760030432000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/9\/1078"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,24]]},"references-count":17,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["diagnostics15091078"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15091078","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,4,24]]}}}