Investigation to predict faecal continence in patients undergoing reversal of a defunctioning stoma (Porridge enema test).
OBJECTIVE
A defunctioning stoma is often performed in cases of major anorectal surgery or sphincter injury. This study aimed to assess the Porridge enema (PE) test as a tool to evaluate function prior to stoma closure.


METHODS
Thirty-eight patients underwent PE test at a median of 12.5 months after stoma formation prior to consideration of stoma closure. Outcome was assessed by immediate leakage after PE test on lying, standing, walking and the ability to hold the enema for 30 min. Patients available for follow-up were divided into two groups: group 1 (n = 20) patients with stoma closure performed and group 2 (n = 10) patients where the stoma remains. Eight patients were excluded from analysis as the stoma had not been reversed for reasons unrelated to continence. The results of other investigations performed in these patients were analysed. Finally, we studied the agreement in the interpretation of the test by two investigators blinded to the patient's group and each other's interpretation and to functional results after the stoma was reversed.


RESULTS
Anorectal physiology testing and imaging assessment of the anal sphincters was not statistically different between the two groups. There was a significant difference in the percentage of patients in each group that had enema leakage in: lying position (P = 0.002), standing position (P = 0.013), walking (P = 0.002) and ability to defer for 30 min (P = 0.005). There was a good correlation in the interpretation of PE test results by two investigators. Among patients whose stoma was closed and who were evaluated functionally, 55% were fully continent.


CONCLUSIONS
This report suggests that the PE test is a promising tool as part of evaluation of anorectal function prior to stoma reversal.
Parés
D
D
St Mark's Hospital, Harrow, UK.
Duncan
J
J
Dudding
T
T
Phillips
R K S
RK
Norton
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology*; D000714:Anastomosis, Surgical; D013505:Digestive System Surgical Procedures / Q000379:methods; D004733:Enema / Q000379:methods*; D005242:Fecal Incontinence / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054047:Surgical Stomas