Skip to main content
SpringerLink
Log in

Vector Volume Manometry and Neurophysiologic Assessment in the Reoperative Case: Recommendations

  • Chapter
  • First Online:
Reconstructive Surgery of the Rectum, Anus and Perineum

  • 2694 Accesses

Abstract

The use of anorectal physiological assessment in the management of patients undergoing reoperative surgery has diminished over the years; it has become clear that functional outcome does not directly correlate with preoperative manometry. Vector volume manometry and neurophysiologic testing are outlined in this chapter along with the interpretation techniques and limitations in their determination and assessment particularly as they pertain to the reoperative case.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Klopper PJ, de Haas F, Dijkhuis T. Computerized experimental multichannel urethral pressure profilometry. World J Urol. 1990;8:159–62.

    Article  Google Scholar 

  2. Bombeck CT, Vaz O, DeSalvo J, Donahue PE, Nyhus LM. Computerized axial manometry of the esophagus: a new method for the assessment of antireflux operations. Ann Surg. 1987;206:465–72.

    Article  CAS  PubMed  Google Scholar 

  3. Perry RE, Blatchford GJ, Christensen MA, Thorson AG, Attwood SEA. Manometric diagnosis of anal sphincter injuries. Am J Surg. 1990;159:112–7.

    Article  CAS  PubMed  Google Scholar 

  4. Taylor BM, Beart RW, Phillips SF. Longitudinal and radial variations of pressure in \the human anal sphincter. Gastroenterology. 1984;86:693–7.

    CAS  PubMed  Google Scholar 

  5. Coller JA. Clinical application of anorectal manometry. Surg Clin N Am. 1987;16:17–33.

    CAS  Google Scholar 

  6. Coller JA, Sangwan Y. Computerized anal sphincter manometry performance and analysis. In: Smith LE, editor. Practical guide to anorectal testing. 2nd ed. New York: Igaku-Shoin; 1995. p. 51–100.

    Google Scholar 

  7. Dijkhuis T, Bendiman WA, van der Hulst VPM, Klopper PJ. Graphical representation of eight-channel pressure profiles on a personal computer. Med Biol Eng Comput. 1990;28:502–4.

    Article  CAS  PubMed  Google Scholar 

  8. Waegermaekers CTBJ. Profilemeting van de distal oesophagus sphincter [thesis]. University of Amsterdam, Amsterdam, 1980

    Google Scholar 

  9. Zbar AP, Aslam M, Hider A, Toomey P, Kmiot WA. Comparison of vector volume manometry and conventional manometry in anorectal dysfunction. Tech Coloproctol. 1998;2:84–90.

    Google Scholar 

  10. Zbar A. Vectorvolume manometry. In: Wexner SD, Zbar AP, Pescatori M, editors. Complex anorectal disorders: investigation and management. New York: Springer; 2005. p. 48–62.

    Chapter  Google Scholar 

  11. Braun JC, Trentner KH, Drew B, Klimaszewski M, Schumpelick V. Vector manometry for differential diagnosis of fecal incontinence. Dis Colon Rectum. 1994;37:989–96.

    Article  CAS  PubMed  Google Scholar 

  12. Keck JO, Staniunas RJ, Coller JA, Barrett RC, Oster ME. Computer-generated profiles of the anal canal in patients with anal fissure. Dis Colon Rectum. 1995;38:72–9.

    Article  CAS  PubMed  Google Scholar 

  13. Williams N, Barlow J, Hobson A, Scott N, Irving M. Manometric asymmetry in the anal canal in controls and patients with faecal incontinence. Dis Colon Rectum. 1995;38:1275–80.

    Article  CAS  PubMed  Google Scholar 

  14. Williams N, Scott A, Irving M. Effect of lateral sphincterotomy on internal anal sphincter function: a computerized vector manometric study. Dis Colon Rectum. 1995;38:700–4.

    Article  CAS  PubMed  Google Scholar 

  15. Sultan AH, Kamm MA, Nicholls RJ, Bartram CI. Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy. Dis Colon Rectum. 1994;37:1031–3.

    Article  CAS  PubMed  Google Scholar 

  16. Zbar AP, Aslam M, Allgar V. Faecal incontinence after internal sphincterotomy for anal fissure. Tech Coloproctol. 2000;4:25–8.

    Article  Google Scholar 

  17. Grande M, Caddedu F, Sileri P, Ciano P, Attina GM, Selvaggio I, et al. Anal vector volume analysis: an effective tool in the management of pelvic floor disorders. Tech Coloproctol. 2011;15:31–7. Epub 2010 Dec 14.

    Article  CAS  PubMed  Google Scholar 

  18. Schizas AMP, Emmanuel AV, Williams AB. Anal canal vector volume manometry. Dis Colon Rectum. 2011;54:759–68.

    Article  PubMed  Google Scholar 

  19. Zbar AP. Reading too much into anal vectorvolumetric parameters: correspondence for “anal vector volume analysis: an effective tool in the management of pelvic floor disorders”. Tech Coloproctol. 2011;15(4):473–4. Epub 2011 Nov 9.

    Article  CAS  PubMed  Google Scholar 

  20. Zbar AP. Anal vectorvolumetry: a bridge too far. Dis Colon Rectum. 2011;54(10):e258. author reply e258.

    Article  PubMed  Google Scholar 

  21. Sultan AH, Kamm MA, Nicholls RJ, Bartram CI. Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy. Dis Colon Rectum. 1994 Oct;37(10):1031–3.

    Google Scholar 

  22. Miller R, Bartolo DCC, Cervero F, Mortensen NJ. Anorectal sampling: a comparison of normal and incontinent patients. Br J Surg. 1988;75:44.

    Article  CAS  PubMed  Google Scholar 

  23. Zbar AP, Kmiot WA, Aslam M, Williams A, Hider A, Audisio RA, et al. Use of vector volume manometry and endoanal magnetic resonance imaging in the adult female for assessment of anal sphincter dysfunction. Dis Colon Rectum. 1999;42:928–33.

    Article  Google Scholar 

  24. Zbar AP, Khaikin M. For debate: should we care about the internal anal sphincter? Dis Colon Rectum. 2012;55(1):105–8.

    Article  PubMed  Google Scholar 

  25. Yang Y-K, Wexner SD. Anal pressure vectography is of no apparent benefit for sphincter evaluation. Int J Colorectal Dis. 1994;9:92–5.

    Article  CAS  PubMed  Google Scholar 

  26. Hussein AM, Shehata MAS, Zaki Y, El Seweify MEA. Computerized anal vector manometric analysis in patients with tailored lateral sphincterotomy for anal fissure. Tech Coloproctol. 2000;4:143–9.

    Article  Google Scholar 

  27. Giordano P, Gravante G, Grondona P, Ruggiero B, Porrett T, Lunniss PJ. Simple cutaneous advancement flap anoplasty for resistant chronic anal fissure: a prospective study. World J Surg. 2009;33:1058–63.

    Article  PubMed  Google Scholar 

  28. Pucciani F, Rottoli ML, Bologna A, Cianchi F, Forconi S, Cutelle M, et al. Pelvic floor dyssynergia and bimodal rehabilitation: results of combined pelviperineal kinesitherapy and biofeedback training. Int J Colorectal Dis. 1998;13:124–30.

    Article  CAS  PubMed  Google Scholar 

  29. Glasgow SC, Birnbaum EH, Kodner IJ, et al. Preoperative anal manometry predicts continence after perineal proctectomy for rectal prolapse. Dis Colon Rectum. 2006;49:1052–8.

    Article  PubMed  Google Scholar 

  30. Zbar AP, Nguyen H. Management guidelines in the treatment of full-thickness prolapse. In: Altomare D, Pucciani F, editors. Rectal Prolapse: Diagnosis and Clinical Management. Rome: Springer; 2008. p. 201–6.

    Google Scholar 

  31. Tjandra JJ, Milsom JW, Schroeder T, Fazio VW. Endoluminal ultrasound is preferable to electromyography in mapping anal sphincteric defects. Dis Colon Rectum. 1993;36:689–92.

    Article  CAS  PubMed  Google Scholar 

  32. Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI. Anal endosonography for identifying external anal sphincter defects confirmed histologically. Br J Surg. 1994;81:463–5.

    Article  CAS  PubMed  Google Scholar 

  33. Chen AS, Luchtefeld MA, Senagore AJ, MacKeigan JM, Hoyt C. Pudendal nerve latency: does it predict outcome after of anal sphincter repair? Dis Colon Rectum. 1998;41:1005–9.

    Article  CAS  PubMed  Google Scholar 

  34. Rosato GO, Lumi CM, Miguel AA. Anal sphincter electromyography and pudendal nerve terminal motor latency assessment. Semin Colon Rectal Surg. 1992;3:68–74.

    Google Scholar 

  35. Beck A. Electromyographische untersuchungen am sphincter ani. Arch Physiol. 1930;224:278–92.

    Article  Google Scholar 

  36. Adrian ED, Bronk DW. The discharge of impulsesd in motor nerve fibers. II. The frequency of discharge in reflex and voluntary contractions. J Physiol. 1929;67:119–51.

    Google Scholar 

  37. Buchtal F. The general concept of the motor unit: neuromuscular disorders. Res Publ Assoc Res Nerv Ment Dis. 1961;38:3–30.

    Google Scholar 

  38. Pette D. Fiber transformation and fiber replacement in chronically stimulated muscle. J Heart Lung Transplant. 1992;11:S299–305.

    CAS  PubMed  Google Scholar 

  39. Chan MK, Tjandra JJ. Sacral nerve stimulation for fecal incontinence: external anal sphincter defect vs. intact anal sphincter. Dis Colon Rectum. 2008;51:1015–25.

    Article  PubMed  Google Scholar 

  40. Iwai N, Kanida H, Taniguchi H, Tsuto T, Yanigahara J, Takahashi T. Postoperative continence assessed by electromyography of the external sphincterin anorectal malformations. Z Kinderchir. 1985;40:87–90.

    CAS  PubMed  Google Scholar 

  41. Wexner SD, Cheape JD, Jorge JMN, Heymen S, Jagelman DG. A prospective assessment of biofeedback for the treatment of ­paradoxical puborectalis contraction. Dis Colon Rectum. 1992;35:145–50.

    Article  CAS  PubMed  Google Scholar 

  42. Fowler CJ. Pelvic floor neurophysiology. Meth Clin Neurophysiol. 1991;2:1–20.

    Google Scholar 

  43. Stälberg E, Trontelj J. Single fiber electromyography. Surrey: Mirvalle; 1979.

    Google Scholar 

  44. Snooks SJ, Swash M. Nerve stimulation techniques. In: Henry MM, Swash M, editors. Coloproctology and the pelvic floor: pathophysiology and management. London: Butterworths; 1985. p. 184–206.

    Google Scholar 

  45. Lauerberg S, Swash M. Effects of ageing on anorectal sphincters and their innervations. Dis Colon Rectum. 1989;32:737–42.

    Article  Google Scholar 

  46. Rosato O, Lumi CM. Neurophysiology in pelvic floor disorders. In: Wexner SD, Zbar AP, Pescatori M, editors. Complex anorectal disorders: investigation and management. London: Springer; 2005. p. 153–69.

    Chapter  Google Scholar 

  47. Winge K, Jennum P, Lokkegaard A, Werdelin L. Anal sphincter EMG in the diagnosis of Parkinsonian syndromes. Acta Neurol Scand. 2010;121:198–203. Epub 2009 Sept 24.

    Article  CAS  PubMed  Google Scholar 

  48. Khealanai B, Husain AM. Neuwophysiologic intraoperative monitoring during surgery for tethered cord syndrome. J Clin Neurophysiol. 2009;26:76–81.

    Article  Google Scholar 

  49. Sakakibara R, Uchiyama T, Yamanishi T, Kishi M. Sphincter EMG as a diagnostic tool in autonomic disorders. Clin Auton Res. 2009;19:20–31.

    Article  PubMed  Google Scholar 

  50. Mesin L, Gazzoni M, Merletti R. Automatic localisation of innervations zones: a simulation study of the external anal sphincter. J Electromyogr Kinesiol. 2009;19:e413–21.

    Article  PubMed  Google Scholar 

  51. Pino LJ, Stashuk DW, Podnar S. Bayesian characterization of external anal sphincter muscles using quantitative electromyography. Clin Neurophysiol. 2008;119:2266–73.

    Article  CAS  PubMed  Google Scholar 

  52. Mesin L, Gervasio R. Detection volume of simulated electrode systems for recording sphincter muscle electromyogram. Med Eng Phys. 2008;30:896–904.

    Article  PubMed  Google Scholar 

  53. Kiff ES, Swash M. Normal proximal and delayed distal conduction in the pudendal nerves of patients with idiopathic (neurogenic) faecal incontinence. J Neurol Neurosurg Psychiatry. 1984;47:820–3.

    Article  CAS  PubMed  Google Scholar 

  54. Ryhammer AM, Lauerberg S, Hermann P. Long-term effect of vaginal deliveries on anorectal function in normal perimenopausal women. Dis Colon Rectum. 1996;39:852–9.

    Article  CAS  PubMed  Google Scholar 

  55. Sangwan YP, Coller JA, Barrett RC, Roberts PL, Murray JJ, Rusin L. Unilateral pudendal neuropathy. Impact on outcome of anal sphincter repair. Dis Colon Rectum. 1996;39:686–9.

    Article  CAS  PubMed  Google Scholar 

  56. Sorensen M, Nielsen MB, Pedersen JF, Christiansen J. Electromyography of the internal anal sphincter performed under endosonographic guidance. Description of a new method. Dis Colon Rectum. 1994;37:138–43.

    Article  CAS  PubMed  Google Scholar 

  57. Merletti R, Bottin A, Cescon C, Farina D, Gazzoni M, Martina S, et al. Multichannel surface EMG for the non-invasive assessment of the anal sphincter muscle. Digestion. 2004;69:112–22.

    Article  CAS  PubMed  Google Scholar 

  58. Enck P, Hinninghofen H, Merletti R, Azpiroz F. The external anal sphincter and the role of surface electromyography. Neurogastroenterol Motil. 2005;17 Suppl 1:60–7.

    Article  PubMed  Google Scholar 

  59. Matzel K, Matzel KE. Sacral nerve stimulation for fecal disorders: evolution, current status, and future directions. Acta Neurochir. 2007;97(Pt 1):351–7. Review.

    CAS  Google Scholar 

  60. Matsushita M, Nakasato N, Nakagawa H, Kanno A, Kaiho Y, Arai Y. Primary somatosensory evoked magnetic fields elicited by sacral surface electrical stimulation. Neurosci Lett. 2008;431:77–80.

    Article  CAS  PubMed  Google Scholar 

  61. Malaguti S, Spinelli M, Giardello G, Lazzeri M, Van Den Hombergh U. Neurophysiological evidence may predict the outcome e of sacral neuromodulation. J Urol. 2003;170(6 Pt 1):2323–6.

    Article  CAS  PubMed  Google Scholar 

  62. Govaert B, Melenhorst J, Nieman FH, Bols EM, van Gemert WG, Baeten CG. Factors associated with percutaneous nerve evaluation and permanent sacral nerve modulation outcome in patients with fecal incontinence. Dis Colon Rectum. 2009;52:1688–94.

    Article  CAS  PubMed  Google Scholar 

  63. Shaker H, Wang Y, Loung D, Balbaa L, Fehlings MG, Hassouna MM. Role of C-afferent fibres in the mechanism of action of sacral root neuromodulation in chronic spinal cord injury. BJU Int. 2000;85:905–10.

    Article  CAS  PubMed  Google Scholar 

  64. Griffiths D. Clinical studies of cerebral and urinary tract function in elderly people with urinary incontinence. Behav Brain Res. 1998;92:151–5.

    Article  CAS  PubMed  Google Scholar 

  65. Blok BF, Stums LM, Holstege G. Brain activation during micturition in women. Brain. 1998;121(Pt 11):2033–42.

    Article  PubMed  Google Scholar 

  66. Blok BF, Groen J, Bosch JL, Veltman DJ, Lammertsmaa AA. Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators. BJU Int. 2006;98:1238–43.

    Article  PubMed  Google Scholar 

  67. Perneczky R, Diehl-Schmid J, Forstl H, Drzezga A, May F, Kurz A. Urinary incontinence and its functional anatomy in frontotemporal lobar degenerations. Eur J Nucl Med Mol Imaging. 2008;35:605–10.

    Article  PubMed  Google Scholar 

  68. Pierce C, Healy CF, O’Herlihy C, O’Connell PR, Jones JFX. Reduced somatosensory cortical activation in experimental models of neuropathic fecal incontinence. Dis Colon Rectum. 2009;52:1417–22.

    Article  Google Scholar 

  69. Sheldon R, Kiff ES, Clarke A, Harris ML, Hamdy S. Sacral nerve stimulation reduces corticoanal excitability in patients with faecal incontinence. Br J Surg. 2005;92:1423–31.

    Article  CAS  PubMed  Google Scholar 

  70. Pellicione G, Scarpinoi O, Piloni V. Motor evoked potentials recorded from external anal sphincter by cortical and lumbo-sacral magnetic stimulation: normative data. J Neurol Sci. 1997;149:69–72.

    Article  Google Scholar 

  71. Hamdy S, Enck P, Aziz Q, Rothwell JC, Uengdergil S, Hobson A, et al. Spinal and pudendal nerve modulation of human corticoanal motor pathways. Am J Physiol. 1998;274(2 Pt 1):G419–23.

    CAS  PubMed  Google Scholar 

  72. Hamdy S, Enck P, Aziz Q, Unergoergil S, Hobson A, Thompson DG. Laterality effects of human pudendal nerve stimulation on corticoanal pathways: evidence for functional asymmetry. Gut. 1999;45:58–63.

    Article  CAS  PubMed  Google Scholar 

  73. Morren GL, Walter S, Lindehammar H, Halböök O, Sjödahl R. Evaluation of the sacroanal motor pathway by magnetic and electrical stimulation in patients with fecal incontinence. Dis Colon Rectum. 2001;44:167–72.

    Article  CAS  PubMed  Google Scholar 

  74. Morren GL, Walter S, Halböök O, Sjödahl R. Effects of magnetic sacral root stimulation on anorectal pressure and volume. Dis Colon Rectum. 2001;44:1827–33.

    Article  CAS  PubMed  Google Scholar 

  75. Lefaucheur JP. Excitability of the motor cortical representation of the external anal sphincter. Exp Brain Res. 2005;160:268–72.

    Article  PubMed  Google Scholar 

  76. Harris ML, Singh S, Rothwell J, Thompson DG, Hamdy S. Rapid rate magnetic stimulation of human sacral nerve roots alters excitability within the cortico-anal pathway. Neurogastroenterol Motil. 2008;20:1132–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery and Transplantation, Chaim Sheba Medical Center, 52621, Ramat Gan, Israel

    Andrew P. Zbar M.D. (Lond), M.B.B.S., FRCS (Ed.), FRACS

  2. Sackler Medical School, Tel Aviv University, Tel Aviv, Israel

    Andrew P. Zbar M.D. (Lond), M.B.B.S., FRCS (Ed.), FRACS

Authors
  1. Andrew P. Zbar M.D. (Lond), M.B.B.S., FRCS (Ed.), FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew P. Zbar M.D. (Lond), M.B.B.S., FRCS (Ed.), FRACS .

Editor information

Editors and Affiliations

  1. Tamworth Rural Referral Hospital, Dean Street, Tamworth, 2340, New South Wales, Australia

    Andrew P. Zbar

  2. Delware Street 420, Minneapolis, 55455, Minnesota, USA

    Robert D. Madoff

  3. , Dept. Colorectal Surgery, Cleveland Clinic, Florida, Cleveland Clinic Blvd. 2950, Weston, 33331, Florida, USA

    Steven Wexner

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Zbar, A.P. (2013). Vector Volume Manometry and Neurophysiologic Assessment in the Reoperative Case: Recommendations. In: Zbar, A., Madoff, R., Wexner, S. (eds) Reconstructive Surgery of the Rectum, Anus and Perineum. Springer, London. https://doi.org/10.1007/978-1-84882-413-3_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-413-3_7

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-412-6

  • Online ISBN: 978-1-84882-413-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation