The value of anal endosonography compared with magnetic resonance imaging following the repair of anorectal malformations

Background: Surgery for anorectal malformations (ARMs) attempts to position the neo-anus anatomically within the anal sphincter complex. Currently, MRI is the imaging modality of choice in determining the position of the neoanus after reconstructive surgery. Objective: The aim of this study was to compare the accuracy of anal endosonography (AES) with conventional MRI in demonstrating the anatomy of the neo-anus following repair of ARMs. Materials and methods: Fourteen children (ten girls, four boys), born with ARMs (four low, ten high) underwent both AES and pelvic MRI following anorectoplasty. The results of both investigations were compared with muscle stimulation and were reported blindly by a clinician and a radiologist. Results: AES findings were comparable with MRI in 9 of the 14 cases. In four cases, MRI and AES findings differed, with nerve stimulation supporting AES but not MRI. Conclusions: AES is an accurate alternative to MRI in the assessment of anorectoplasty. It provides more detailed information and can be performed under anaesthesia in combination with a surgical procedure.