Anorectal function following low anterior resection.
BACKGROUND
Rectal function following rectal resection for carcinoma was studied in 43 patients.


METHODS
Sixteen women and 27 men with a median age of 66 years (range 41-79 years) were included. Twenty-three patients had a diverting ileostomy at the time of resection. Eight patients had a 6-cm colonic J-pouch. Ten patients had anastomotic leakage including two patients without diverting ileostomy. One patient had pre-operative radiation with 25 Gy. The patients were studied at a median 12 months (range 3-30) after rectal resection. Distance from anal verge to the anastomosis was a median 7 cm (range 3-12 cm). Clinical data, anal manometry and rectal compliance were analysed.


RESULTS
Stool frequency was 3 per day (range 1-10). Twenty-two (51%) patients were continent, 11 (26%) were incontinent for flatus, and 10 (23%) were incontinent for faeces (three for liquid and seven for solid stool). Fourteen (33%) patients had constipation, two of whom also had incontinence for solid or liquid stool. The level of the anastomosis for patients with postoperative constipation was 5 cm (range 3-12 cm), while it was 7 cm (range 3-10 cm) for nonconstipated patients (NS). Anal manometry was normal. Rectal compliance was lower in patients with incontinence for liquid or solid faeces than in patients with flatus incontinence only (P < 0.01), and rectal volume tolerability was lower in incontinent patients compared with continent patients (P < 0.05). The rectoanal reflex was present in 31 (72%) patients. There was a negative correlation between maximal rectal volume and stool frequency and between level of the anastomosis and degree of incontinence. Age did not affect functional outcome.


CONCLUSIONS
Many patients had a poor functional result following low anterior resection. One in four suffered from incontinence to liquid or solid faeces and one third of the patients experienced constipation. A low level of anastomosis tended to increase stool frequency and carried a higher risk of incontinence. Patients with faecal incontinence tended to have lower rectal compliance and volume tolerability than patients who were continent, while there was no difference in anal pressures.
Rasmussen
O O
OO
Department of Surgery D, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark. olra@herlevhosp.kbhamt.dk
Petersen
I K
IK
Christiansen
J
J
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003248:Constipation / Q000209:etiology* / Q000503:physiopathology*; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D020127:Recovery of Function / Q000502:physiology*; D012004:Rectal Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors