Skip to main content

Advertisement

SpringerLink
Log in

Sacral Nerve Terminal Motor Latency in Patients With or Without Soiling More Than 2 Years After Low Anterior Resection for Low Rectal Cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

To clarify the neurologic function with respect to puborectalis muscle (PM) in patients after low anterior resection (LAR) for low rectal cancer, author examined the sacral nerve terminal motor latency (SNTML) of the PM.

Methods

The latency of the response in the PM following transcutaneous magnetic stimulation of the cauda equina at the levels from S3 to S4 by SNTML was measured in 33 patients after LAR. They were divided into groups. Group A, which experienced soiling, comprised 15 patients (11 men, 4 women) aged 58 to 77 years (mean 63.5 years). Group A was further divided into patients having soiling with mucous secretions and feces on underwear on awaking everyday (group A1, 9 cases) and those with soiling during the daytime only when diarrhea occurred (group A2, 6 cases). Group B, which did not experience soiling comprised 18 patients (12 men, 6 women), aged 47 to 76 years (mean 62.2 years). The results from the groups were compared with data obtained from 33 control subjects (group C), who comprised 23 men and 10 women, aged 47 to 74 years (mean 62.4 years).

Results

The distance of the anastomosis from the dentate line (DL) in group A1 was significant shorter than in groups A2 and B (p = 0.0071, p < 0.0001, respectively). Patients in group A displayed significant prolongation of the SNTML values compared with patients in groups B and C at the right, left, and posterior sites (all p < 0.0001). Moreover, patients in group B showed more extended SNTML than those in group C at all sites. Patients in group A1 exhibited significant prolongation of the SNTML compared with patients in groups A2 and B at all sites (all p < 0.0001). Moreover, patients in group A2 showed more prolonged SNTML than those in group B at all sites. A significant correlation was found between the distance of the anastomosis from the DL and the SNTML values at all sites of the PM (right side: r = 0.786, p < 0.0001; left side: r = 0.739, p < 0.0001; posterior: r = 0.773, p < 0.0001).

Conclusions

Soiling after LAR may be caused by damage to the bilateral sacral motor nerves.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Otto IC, Ito K, Hibi K et al (1996) Causes of rectal incontinence after sphincter-preserving operations for rectal cancer. Dis Colon Rectum 39:1423–1427

    Article  PubMed  CAS  Google Scholar 

  2. Adachi Y, Kakisaka K, Sato K et al (2000) Factors influencing bowel function after low anterior resection and sigmoid colectomy. Hepatogastroenterology 47:155–158

    PubMed  CAS  Google Scholar 

  3. Rasmussen OO, Petersen IK, Christiansen J (2003) Anorectal function following low anterior resection. Colorectal Dis 5:258–261

    Article  PubMed  CAS  Google Scholar 

  4. Ratto C, Grillo E, Parello A et al (2005) Sacral neuromodulation in treatment of fecal incontinence following anterior resection and chemoradiation for rectal cancer. Dis Colon Rectum 58:1027–1036

    Article  Google Scholar 

  5. Mochiki E, Nakabayashi T, Suzuki H et al (2001) Barostat examination of proximal site of the anastomosis in patients with rectal cancer after low anterior resection. World J Surg 25:1377–1382

    PubMed  CAS  Google Scholar 

  6. Iizuka I, Koda K, Seike K et al (2004) Defecatory malfunction caused by motility disorder of the neorectum after anterior resection for rectal cancer. Am J Surg 188:176–180

    Article  PubMed  Google Scholar 

  7. Ho YH, Seow-Choen F, Tan M (2001) Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized control trial. World J Surg 25:876–881

    Article  PubMed  CAS  Google Scholar 

  8. Yamana T, Oya M, Komatsu J et al (1999) Preoperative anal sphincter pressure zone, maximum tolerable volume, and anal mucosal electrosensitivity predict early postoperative defecatory function after low anterior resection for rectal cancer. Dis Colon Rectum 42:1145–1151

    Article  PubMed  CAS  Google Scholar 

  9. Rao SS, Hatfield R, Soffer E et al (1999) Manometric tests of anorectal function in healthy adults. Am J Gastroenterol 94:773–783

    Article  PubMed  CAS  Google Scholar 

  10. Tomita R, Igarashi S, Fujisaki S et al (2008) A pathophysiological study using anorectal manometry on patients with or without soiling 5 years or more after low anterior resection for lower rectal cancer. Hepatogastroenterology 55:1584–1588

    PubMed  Google Scholar 

  11. Chatwin NAM, Ribordy M, Givel JC (2002) Clinical outcomes and quality of life after low anteror resection for rectal cancer. Eur J Surg 168:297–301

    Article  PubMed  Google Scholar 

  12. Matsuoka H, Masaki T, Sugiyama M, Atomi Y (2007) Pudendal nerve terminal motor latency in evaluation of evacuatory disorder following low anterior resection. Hepatogastroenterology 54:1426–1429

    PubMed  Google Scholar 

  13. Shafik A (1986) A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation: reversion to normal defecation after combined excision operation and end colostomy for rectal cancer. Am J Surg 151:278–284

    Article  PubMed  CAS  Google Scholar 

  14. Azpiroz F, Fernandez-Fraga X et al (2005) The puborectalis muscle. Neurogastroenterol Motil 17:68–72

    Article  PubMed  Google Scholar 

  15. Liu J, Guaderrama N, Nager CW et al (2006) Functional correlates of anal canal anatomy: puborectalis muscle and anal canal pressure. Am J Gastroenterol 101:1092–1097

    Article  PubMed  Google Scholar 

  16. Fucini C, Elbetti C, Masserrini L (1999) Anatomic plane of separation between external anal sphincter and puborectalis muscle. Dis Colon Rectum 42:374–379

    Article  PubMed  CAS  Google Scholar 

  17. Snook SJ (1986) The innervation of the muscles of continence. Ann R Coll Surg Engl 68:45–49

    Google Scholar 

  18. Barber M, Bremer RE, Thor KB et al (2001) Innervation of the female levator ani muscles. Am J Obstet Gynecol 187:64–71

    Article  Google Scholar 

  19. Vassilakis JS, Pechlivanides G, Zoras OJ et al (1995) Anorectal function after low anterior resection of the rectum. Int J Colorectal Dis 10:101–106

    Article  PubMed  CAS  Google Scholar 

  20. Di Mattio G, Mascagni D, Zeri KP et al (2000) Evaluation of function after surgery for rectal cancer. J Surg Oncol 74:11–14

    Article  Google Scholar 

  21. Guren MG, Eriksen MT, Wiig JN et al (2005) Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol 31:735–742

    Article  PubMed  CAS  Google Scholar 

  22. Montesani C, Pronio A, Santella S et al (2004) Rectal cancer surgery with sphincter preservation: functional results related to the level of anastomosis: clinical and instrument study. Hepatogastroenterology 51:718–721

    PubMed  Google Scholar 

  23. Hida J, Yoshifugi T, Matsuzaki T et al (2007) Long-term functional changes after low anterior resection for rectal cancer compared between a colonic J-pouch and a straight anastomosis. Hepatogastroenterology 54:407–413

    PubMed  Google Scholar 

  24. Jost WH, Schimrigk K (1994) Magnetic stimulation of the pudendal nerve. Dis Colon Rectum 37:697–699

    Article  PubMed  CAS  Google Scholar 

  25. Sato T, Konishi F, Kanazawa K (2000) Variations in motor evoked potential latencies in the anal sphincter system with sacral magnetic stimulation. Dis Colon Rectum 43:966–970

    Article  PubMed  CAS  Google Scholar 

  26. Matzel KE, Stadelmaier U, Hohenfellner M et al (2002) Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection. Int J Colorectal Dis 17:430–434

    Article  PubMed  Google Scholar 

  27. Altomare DF, Rinaldi M, Petrolino M et al (2005) Reliability of electrophysiologic anal tests in predicting the outcome of sacral nerve modulation for fecal incontinence. Dis Colon Rectum 48:1668–1669

    Article  Google Scholar 

  28. Hetzer FH, Hahnloser D, Clavien PA et al (2007) Quality of life and morbidity after permanent sacral nerve stimulation for fecal incontinence. Arch Surg 142:8–13

    Article  PubMed  Google Scholar 

  29. Tomita R, Kurosu Y, Isozumi M et al (1995) Sacral nerve terminal latency after ileal J pouch anastomosis for ulcerative colitis. Surg Today 25:946–949

    Article  PubMed  CAS  Google Scholar 

  30. Tomita R, Kurosu Y, Munakata K (1996) Electrophysiologic assessments in pudendal and sacral motor nerves after ileal J-pouch: anal anastomosis for patients with ulcerative colitis and adenosis coli. Dis Colon Rectum 39:410–415

    Article  PubMed  CAS  Google Scholar 

  31. Jorge JMN, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Nippon Dental University Hospital, School of Life Dentistry at Tokyo, 2-3-16 Fujimi Chiyoda-ku, Tokyo, 102-8158, Japan

    Ryouichi Tomita

Authors
  1. Ryouichi Tomita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryouichi Tomita.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tomita, R. Sacral Nerve Terminal Motor Latency in Patients With or Without Soiling More Than 2 Years After Low Anterior Resection for Low Rectal Cancer. World J Surg 33, 1495–1501 (2009). https://doi.org/10.1007/s00268-009-0035-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-0035-1

Keywords

Search

Navigation