Extracorporeal magnetic stimulation in the medical rehabilitation of children who underwent surgery for anorectal malformations

BACKGROUND: Anorectal malformations represent a significant group of congenital developmental anomalies in children. A critical issue in pediatric surgery is the development of effective rehabilitation strategies following proctoplasty. Medical rehabilitation aims to normalize bowel transit, restore the tone of the rectal sphincter and pelvic floor muscles, reestablish the defecation reflex, and reduce asthenovegetative dysfunctions. AIM: To substantiate the use of extracorporeal magnetic stimulation in rehabilitation of children who underwent surgery for anorectal malformations. MATERIALS AND METHODS: As part of an open controlled clinical study, 77 children (mean age 5.99±3.22 years) who had undergone surgery for anorectal malformations were monitored over time. They were included into either of two groups: 39 children received extracorporeal magnetic stimulation, whereas 38 children did not have any physiotherapeutic interventions. All children participated in therapeutic exercises for strengthening the pelvic floor muscles. To evaluate treatment efficacy, ultrasound imaging of the perineum and pelvic floor structures was performed, along with Doppler ultrasonography of the rectal vasculature. RESULTS: Extracorporeal magnetic stimulation was associated with a positive clinical response, including improved colonic evacuatory function and decreased episodes of fecal soiling. Ultrasound demonstrated statistically significant increases in the anal canal width, levator muscle dimensions (p=0.04), external sphincter thickness on the right (p=0.004) and left (p=0.012) sides, and puborectalis sling size (p=0.009). A trend toward improved intramural blood flow parameters was observed based on Doppler ultrasonography of the pull-through rectum. However, long-term follow-up at 3, 6, and 12 months indicated a gradual decline in the achieved therapeutic effects. CONCLUSIONS: The studies showed that extracorporeal magnetic stimulation has a positive impact on key clinical and functional parameters in children with anorectal malformations. Analysis of long-term outcomes supports the feasibility of repeated extracorporeal magnetic stimulation courses to maintain therapeutic benefits.