Purpose
Vectorgraphy as an integrated mapping of radial pressure profiles of the anal canal has been used to attempt identification of pressure-related defects with doubtful reliability since vectorgraphs bear no resemblance to endoanal ultrasound scans at similar levels in the anal canal. This study aimed to devise a technique to enable vectorgraphy to be more representative of sphincter function and integrity.
Methods
Vectormanometry was performed in 50 patients with anorectal disorders using an Arndorfer pneumohydraulic system. “Normal” three-dimensional manometric images of each 0.5 cm of the anal sphincter were computer-generated by plotting anal pressures at rest and during squeeze radially around a central zero axis. The graphs were replotted with zero at the periphery and maximal anal pressure at the center. Both this (“inverted”) and “normal” vectorgraphs were compared with endoanal ultrasound images at similar levels, assessing both internal and external anal sphincters.
Results
Standard vectormanometry produced excellent pictures of pressures throughout the anal canal; the anatomy however bore no resemblance to the pictures produced by endoanal ultrasound. The inverted vectographs showed a much better correlation with endoanal ultrasound at each 0.5-mm level of the anal canal, for both squeeze pressure graphs and external sphincter correlations and for resting pressure graphs and internal sphincter correlations.
Conclusions
Accurate assessment of sphincter integrity is not possible when interpreting the vectormanometry graphs in the current format; however, inverted vectorgraphy gives good correlations with endoanal ultrasound and provides combined functional (pressure measurement) and anatomic (three-dimensional profile) information regarding the anal canal.
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PL Roberts JA Coller DJ Schoetz SuffixJr MC Veidenheimer (1990) ArticleTitleManometric assessment of patients with obstetric injuries and fecal incontinence Dis Colon Rectum 33 16–20 Occurrence Handle2295272 Occurrence Handle1:STN:280:By%2BC3cjmt1A%3D Occurrence Handle10.1007/BF02053195
JC Braun KH Treutner B Dreuw M Klimaszewski V Schumpelick (1994) ArticleTitleVectormanometry for differential diagnosis of fecal incontinence Dis Colon Rectum 37 989–996 Occurrence Handle7924720 Occurrence Handle1:STN:280:ByqD3cbit1M%3D Occurrence Handle10.1007/BF02049310
YK Yang SD Wexner (1994) ArticleTitleAnal pressure vectography is of no apparent benefit for sphincter evaluation Int J Colorectal Dis 9 92–95 Occurrence Handle8064197 Occurrence Handle1:STN:280:ByuA2c3nvFc%3D Occurrence Handle10.1007/BF00699420
PJ Law MA Kamm CI Bartram (1990) ArticleTitleA comparison between electromyography and anal endosonography in mapping external anal sphincter defects Dis Colon Rectum 33 370–373 Occurrence Handle2183977 Occurrence Handle1:STN:280:By%2BB38fgvFI%3D Occurrence Handle10.1007/BF02156260
MA Cuesta S Meijer EJ Derksen H Boutkan SG Meuwissen (1992) ArticleTitleAnal sphincter imaging in fecal incontinence using endosonography Dis Colon Rectum 35 59–63 Occurrence Handle1733685 Occurrence Handle1:STN:280:By2C38fitVE%3D Occurrence Handle10.1007/BF02053340
R Farouk DC Bartolo (1994) ArticleTitleThe use of endoluminal ultrasound in the assessment of patients with fecal incontinence J R Coll Surg Edinb 39 312–318 Occurrence Handle7861344 Occurrence Handle1:STN:280:ByqC28rjsVY%3D
R Emblem G Dhaenens R Stien L Morkrid AO Aasen A Bergan (1994) ArticleTitleThe importance of anal endosonography in the evaluation of idiopathic fecal incontinence Dis Colon Rectum 37 42–48 Occurrence Handle8287746 Occurrence Handle1:STN:280:ByuC3MnjvVw%3D Occurrence Handle10.1007/BF02047213
NA Rieger JL Sweeney DC Hoffmann JF Young A Hunter (1996) ArticleTitleInvestigation of fecal incontinence with endo-anal ultrasound Dis Colon Rectum 39 860–864 Occurrence Handle8756840 Occurrence Handle1:STN:280:BymA38fhvVY%3D Occurrence Handle10.1007/BF02053983
JJ Tjandra JW Milsom VW Fazio (1993) ArticleTitleEndoluminal ultrasound is preferable to electromyography in mapping anal sphincter defects Dis Colon Rectum 36 689–692 Occurrence Handle8348854 Occurrence Handle1:STN:280:ByyA2M7ltFQ%3D Occurrence Handle10.1007/BF02238597
N Williams J Barlow A Hobson N Scott M Irving (1995) ArticleTitleManometric asymmetry in the anal canal in controls and patients with fecal incontinence Dis Colon Rectum 38 1275–1280 Occurrence Handle7497839 Occurrence Handle1:STN:280:BymC3c7lsFM%3D Occurrence Handle10.1007/BF02049152
RF Wong ES Bonapace SuffixJr CY Chung JB Liu HP Parkman LS Miller (1998) ArticleTitleSimultaneous endoluminal sonography and manometry to assess anal sphincter complex in normal subjects Dig Dis Sci 43 2363–2372 Occurrence Handle9824120 Occurrence Handle1:STN:280:DyaK1M%2FjvFOhtA%3D%3D Occurrence Handle10.1023/A:1026605409557
AP Zbar WA Kmiot M Aslam et al. (1999) ArticleTitleUse of vector volume manometry and endoanal magnetic resonance imaging in the adult female for assessment of anal sphincter dysfunction Dis Colon Rectum 42 1411–1418 Occurrence Handle10566528 Occurrence Handle1:STN:280:DC%2BD3c%2FjtVyjtg%3D%3D Occurrence Handle10.1007/BF02235038
MM Fynes M Behan C O’Herlihy PR O’Connell (2000) ArticleTitleAnal vector volume analysis complements endoanal ultrasonographic assessment of postpartum anal sphincter injury Br J Surg 87 1209–1214 Occurrence Handle10971430 Occurrence Handle1:STN:280:DC%2BD3M%2Fjs1Okuw%3D%3D Occurrence Handle10.1046/j.1365-2168.2000.01515.x
JM Jorge A Habr-Gama (2000) ArticleTitleThe value of sphincter asymmetry index in anal incontinence Int J Colorectal Dis 15 303–310 Occurrence Handle11151434 Occurrence Handle1:STN:280:DC%2BD3M7ptV2jsQ%3D%3D Occurrence Handle10.1007/s003840000249
T Schuster I Joppich K Schneider G Jobst (2000) ArticleTitleA computerised vector manometry study of the so-called ectopic anus Pediatr Surg Int 16 8–14 Occurrence Handle10663825 Occurrence Handle1:STN:280:DC%2BD3c7jtV2lsg%3D%3D Occurrence Handle10.1007/s003830050003
T Schuster F Lagler T Pfluger HG Dietz (2001) ArticleTitleA computerized vector manometry and MRI study in children following posterior sagittal anorectoplasty Pediatr Surg Int 17 48–53 Occurrence Handle11294269 Occurrence Handle1:STN:280:DC%2BD3Mzot1SktQ%3D%3D Occurrence Handle10.1007/s003830000437
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Kaur, G., Gardiner, A. & Duthie, G.S. A New Method of Assessing Anal Sphincter Integrity Using Inverted Vectormanometry. Dis Colon Rectum 49, 1160–1166 (2006). https://doi.org/10.1007/s10350-006-0556-8
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DOI: https://doi.org/10.1007/s10350-006-0556-8