title: Coordinated activity of the new "rectum" and anal sphincter after sphincter-saving resection of the rectum for colitis or carcinoma.
abstract: OBJECTIVE
  The aim of this study was to determine whether coordinated activity exists across a stapled enteroanal anastomosis.
  
  
  METHODS
  Twenty-nine patients were studied for a median of one year after complete excision of the rectum and stapled enteroanal anastomosis; 12 patients underwent low anterior resection with coloanal anastomosis for carcinoma, and 17 patients underwent restorative proctocolectomy with ileoanal anastomosis.
  
  
  RESULTS
  Maximum anal resting pressures were slightly lower after coloanal anastomosis than after ileoanal anastomosis [median range, 56 (11-60) cm H2O, cf 69 (40-107) cm H2O, P = NS]. During distention of the neorectum, anal sphincter pressures at 2.5, 1.5, and 0.5 cm from the anal verge were significantly lower after coloanal anastomosis compared with after ileoanal anastomosis (P < 0.01 at each station). The volume of neorectal distention required to produce maximal inhibition of the anal sphincter was significantly less after coloanal anastomosis at 50 (range, 20-60) ml of air than after ileoanal anastomosis at 240 (range, 100-420) ml of air (P < 0.01). Minor fecal leakage and urgency of bowel action were significantly more common after coloanal anastomosis (P < 0.01).
  
  
  CONCLUSIONS
  Alterations in the dynamic response of the anal sphincter to distention of the neorectum may explain why the clinical results were better after ileal pouch-anal anastomosis than after coloanal anastomosis.
authors.affiliation: Department of Surgery, General Infirmary, Leeds, Yorkshire, United Kingdom.
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
authors.forename: P J
authors.initials: PJ
authors.lastname: Holdsworth
authors.forename: P M
authors.initials: PM
authors.lastname: Sagar
authors.forename: B M
authors.initials: BM
authors.lastname: Stephenson
authors.forename: P J
authors.initials: PJ
authors.lastname: Finan
authors.forename: D
authors.initials: D
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery*; D003106:Colon / Q000601:surgery*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011312:Pressure; D016737:Proctocolectomy, Restorative; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology / Q000601:surgery; D012146:Rest; D017792:Surgical Stapling