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Coordinated activity of the new “rectum” and anal sphincter after sphincter-saving resection of the rectum for colitis or carcinoma

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Diseases of the Colon & Rectum

Abstract

PURPOSE: 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). CONCLUSION: 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.

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References

  1. Parks AG. Benign tumors of the rectum. In: Rob C, Smith R, Morgan CN, eds. Clinical Surgery. Vol 10. London: Butterworths, 1966:541.

    Google Scholar 

  2. Karanjia ND, Schache DJ, Heald RJ. Function of the distal rectum after low anterior resection for carcinoma. Br J Surg 1992;79:114–6.

    PubMed  Google Scholar 

  3. Pemberton JH, Kelly KA, Beart RW, Dozois RR, Wolff BG, Ilstrup DM. Ileal pouch-anal anastomosis for chronic ulcerative colitis: long-term results. Ann Surg 1987;206:504–13.

    PubMed  Google Scholar 

  4. Nicholls RJ, Pezim ME. Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparison of three reservoir designs. Br J Surg 1985;72:470–4.

    PubMed  Google Scholar 

  5. Utsunomiya J, Iwama T. The J ileal pouch-anal anastomosis: the Japanese experience. In: Dozois RR, ed. Alternatives to conventional ileostomies. Chicago: Year Book Medical Publishers, 1985:371–83.

    Google Scholar 

  6. Lewis WG, Holdsworth PJ, Sagar PM, Holmfield JH, Johnston D. Effect of anorectal eversion during restorative proctocolectomy on anal sphincter function. Br J Surg 1993;80:121–3.

    PubMed  Google Scholar 

  7. Johnston D, Holdsworth PJ, Nasmyth DG,et al. Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis: a pilot study comparing end-to-end ileo-anal anastomosis without mucosal resection with mucosal proctectomy and endo-anal anastomosis. Br J Surg 1987;74:940–4.

    PubMed  Google Scholar 

  8. Keighley MR, Henry MM, Bartolo DC, Mortensen NJ. Anorectal physiology measurement: report of a working party. Br J Surg 1989;76:356–7.

    PubMed  Google Scholar 

  9. Roe AM, Bartolo DC, Mortensen NJ. A new method for assessment of anal sensation in various anorectal disorders. Br J Surg 1986;73:310–2.

    PubMed  Google Scholar 

  10. Cohen L, Holliday M. Statistics for social scientists. London: Harper and Row, 1982.

    Google Scholar 

  11. Lane RH, Parks AG. Function of the anal sphincters following colorectal anastomosis. Br J Surg 1977;64:596–9.

    PubMed  Google Scholar 

  12. Nissen R. Sitzungsberichte aus chirurgichen Gesellschaften Berliner Gesellschaft fur Chirurgie (Offizieller Bericht). Siitzung von 14 Nov. Zentralbl Chir 1932;60:888.

    Google Scholar 

  13. Devine J, Webb R. Resection of the rectal mucosa, colectomy and anal ileostomy with normal continence. Surg Gynecol Obstet 1951;92:437–42.

    PubMed  Google Scholar 

  14. Martin LW, Lecoultre C, Schubert WK. Total colectomy and mucosal proctectomy with preservation of continence in ulcerative colitis. Ann Surg 1977;186:477–80.

    PubMed  Google Scholar 

  15. Nasmyth DG, Johnston D, Godwin PGR, Dixon MF, Smith A, Williams NS. Factors influencing bowel function after ileal pouch-anal anastomosis. Br J Surg 1986;73:469–73.

    PubMed  Google Scholar 

  16. Lewis WG, Sagar PM, Holdsworth PJ, Axon AT, Johnston D. Restorative proctocolectomy with end to end pouch-anal anastomosis in patients over the age of fifty. Gut 1993;34:948–52.

    PubMed  Google Scholar 

  17. Horgan PG, O'Connell Shinkwin CA, Kirwan WO. Effect of anterior resection on anal sphincter function. Br J Surg 1989;76:783–6.

    PubMed  Google Scholar 

  18. Nicholls RJ, Belliveau P, Neill M, Wilks M, Tabaquali S. Restorative proctocolectomy with ileal reservoir: a pathophysiological assessment. Gut 1981;22:462–8.

    PubMed  Google Scholar 

  19. Gowers WR. The automatic action of the sphincter ani. Proc R Soc Lond [Biol] 1877;26:77–84.

    Google Scholar 

  20. Bennett RC, Duthie HL. The functional importance of the internal anal sphincter. Br J Surg 1964;51:355–7.

    PubMed  Google Scholar 

  21. Lewis WG, Holdsworth PJ, Stephenson BM, Finan PJ, Johnston D. Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal carcinoma. Br J Surg 1992;79:1082–6.

    PubMed  Google Scholar 

  22. Sagar PM, Holdsworth PJ, Johnston D. Correlation between laboratory findings and clinical outcome after restorative proctocolectomy: serial studies in 20 patients with end-to-end pouch-anal anastomosis. Br J Surg 1991;78:67–70.

    PubMed  Google Scholar 

  23. Lazorthes F, Fages P, Chiotasso P, Lenozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum. Br J Surg 1986;73:136–8.

    PubMed  Google Scholar 

  24. Parc R, Tiret E, Frileux P, Moszowski E, Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg 1986;73:139–41.

    PubMed  Google Scholar 

  25. Nicholls RJ, Lubowski DZ, Donaldson DR. Comparison of colonic reservoir and straight colo-anal reconstruction after rectal excision. Br J Surg 1988;75:318–20.

    PubMed  Google Scholar 

  26. Kusunoki M, Shoji Y, Yanagi H,et al. Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis. Br J Surg 1991;78:1434–8.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, The General Infirmary, Leeds, Yorkshire, UK

    Wyn G. Lewis F.R.C.S., Peter J. Holdsworth F.R.C.S., Peter M. Sagar F.R.C.S., Brian M. Stephenson F.R.C.S., Paul J. Finan M.D. & David Johnston M.D.

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  1. Wyn G. Lewis F.R.C.S.
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  2. Peter J. Holdsworth F.R.C.S.
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  3. Peter M. Sagar F.R.C.S.
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  4. Brian M. Stephenson F.R.C.S.
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  5. Paul J. Finan M.D.
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  6. David Johnston M.D.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.

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Lewis, W.G., Holdsworth, P.J., Sagar, P.M. et al. Coordinated activity of the new “rectum” and anal sphincter after sphincter-saving resection of the rectum for colitis or carcinoma. Dis Colon Rectum 37, 1012–1019 (1994). https://doi.org/10.1007/BF02049315

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  • DOI: https://doi.org/10.1007/BF02049315

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