HIGH-RESOLUTION ANORECTAL MANOMETRY (HRAM): ITS ROLE IN THE PREOPERATIVE ASSESSMENT OF DEFECATION DYSFUNCTION
Keywords:
high-resolution anorectal manometry, HRAM, defecation dysfunction, dyssynergic defecation, obstructive defecation syndrome, fecal incontinence, preoperative assessment, London classificationAbstract
Functional anorectal disorders, including chronic constipation, fecal incontinence, and obstructive defecation syndrome (ODS), affect 10–25% of the population in developed countries and significantly impair patients’ quality of life. High-resolution anorectal manometry (HRAM) has revolutionized the physiological assessment of the anorectal region by simultaneously recording pressures at high spatial resolution and displaying them as colored topographic maps — so-called Clouse plots. Unlike conventional manometry with a limited number of sensors, HRAM provides an objective, dynamic, and reproducible evaluation of sphincter tone, rectoanal coordination, and rectal sensitivity. This review systematizes data on HRAM technical principles and protocols, normative values and their interpretation, diagnostic value in dyssynergic defecation, ODS, and fecal incontinence, as well as the role of HRAM in comprehensive preoperative assessment compared with adjunctive investigative methods. Accumulated evidence confirms that HRAM is an indispensable preoperative tool, enabling physiological stratification of patients and optimization of surgical strategy.
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