Acute alterations in anorectal manometry induced by proximal and distal sphincterotomy. Experimental studies on piglets

摘要

Anal incontinence causes psychological, social and adaptive troubles prejudicial to the quality of life both in children and adults. Therefore, the detailed knowledge of its causes and the improvement of diagnostic and therapeutic methods increase the possibilities of a more adequate social life to patients with congenital anomalies or sphincteric lesions or degenerations. In this work, a manometric study was developed through an experimental model so as to analyze alterations in behavior of muscle groups responsible for the anorectal sphincteric mechanism, previous to and after proximal and distal lesions. Twenty-two pigs aged between 25 and 30 days, weighing 5–7 kg, were randomly divided into two groups. They were submitted to lesions of different levels in the anorectal muscle. The animals were studied by anorectal manometry (rectoanal inhibitory reflex and vector volume) before and after the lesions. The Student t test and the Wilcoxon test were applied for the statistical analyses, considered p ≤ 0.05. The proximal lesion preserved sphincter relaxation, retarding its closure [speed of relaxation recovery 4.35 ± 2.10 vs. 2.70 ± 1.32 mm/s (p = 0.001)], but it reduced the maximum pressure [62.45 ± 20.02 vs. 40.36 ± 12.59 mmHg (p = 0.004)] and vector volume [2,749 ± 921 vs. 1,591 ± 1,379 mmHg2cm (p = 0.005)]. There was an increment in the high-pressure zone [5.09 ± 1.04 vs. 6.36 ± 1.50 mm (p = 0.005)], but the asymmetry percentage and the sphincter length were maintained. The distal lesion did not alter the rectoanal inhibitory reflex, the high-pressure zone length, the asymmetry percentage, or the vector volume. Nevertheless, the sphincter length increased [11.82 ± 2.82 vs. 14.09 ± 2.39 mm (p = 0.022)] and the maximum pressure decreased [60.55 ± 22.05 vs. 40.91 ± 13.41 mmHg (p = 0.004)]. The alterations observed due to proximal lesion of the anorectal sphincter suggest a direct and more important interference of the levator ani muscle in the function of the sphincteric musculature than that caused by the distal lesion.