Abstract
Treatment options are limited for intractable excessive stool frequency and incontinence after low anterior resection for rectal cancer. Fortunately, this is quite rare, but three such patients were reported. The patients did not respond to two years of expectant treatment, including medications and anorectal biofeedback. Anorectal physiologic tests and endoanal ultrasound findings were consistent with internal anal sphincter injuries, which are known to occur with transanal insertion of stapling instruments. After postanal sphincter repair, stool frequency was reduced from 5.7 (standard error of the mean, 1.3) to 1.7 (0.3) stools per day. Fecal incontinence requiring pads in all patients was reduced to full continence in two patients and gas incontinence in one. Continence score improved from 13.7 (2.2) to 1.3 (0.3). Mean follow-up was 3.2 (0.5) years. Postanal sphincter repair could be considered when persistent bowel dysfunction after anterior resection is caused by internal sphincter injury.
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Ho YH, Low D, Goh HS. Bowel function survey after segmental colorectal resections. Dis Colon Rectum 1996;39:307–10.
Ho YH, Tan M, Seow-Choen F. Prospective randomised controlled study of clinical function and anorectal physiology after low anterior resection, comparing straight with colonic J pouch anastomoses. Br J Surg 1996;83:978–80.
Ho YH, Wong J, Goh HS. Level of anastomosis and anorectal manometry in predicting function following anterior resection for adenocarcinoma. Int J Colorectal Dis 1993;8:170–4.
Ho YH, Tan M, Leong A, Eu KW, Nyam D, Seow-Choen F. Anal pressures impaired by stapler insertion during colorectal anastomosis: a randomized, controlled trial. Dis Colon Rectum 1999;42:89–95.
Ho YH, Tsang C, Tang CL, Nyam D, Eu KW, Seow-Choen F. Anal sphincter injuries from stapling instruments introduced transanally: randomized, controlled study with endoanal ultrasound and anorectal manometry. Dis Colon Rectum 2000;43:169–73.
Griffen FD, Knight CD Sr, Knight CD Jr. Results of the double stapling procedure in pelvic surgery. World J Surg 1992;16:866–71.
Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.
Henry MM, Swash M. Coloproctology and the pelvic floor. 2nd ed. Oxford: Butterworth-Heinemann, 1992:264–70.
Ho Y, Seow-Choen F, Tan M. Randomized, controlled trial of straight and colonic J-pouch anastomosis bowel function and anorectal physiology at two years [meeting abstract]. Dis Colon Rectum 2000;43:A36.
Ho YH, Tan M, Leong AF, Seow-Choen F. Ambulatory manometry in patients with colonic J-pouch or straight coloanal anastomoses: randomized, controlled trial. Dis Colon Rectum 2000;43:793–9.
Ho YH, Chiang JM, Tan M, Low JY. Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy. Dis Colon Rectum 1996;39:1289–92.
Ho YH, Tan M. Biofeedback therapy for bowel dysfunction following low anterior resection. Ann Acad Med Singapore 1997;26:299–302.
Yoshioka K, Hyland G, Keighley MR. Physiological changes after postanal repair and the parameters predicting outcome. Br J Surg 1988;75:1220–4.
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Ho, YH. Postanal sphincter repair for anterior resection anal sphincter injuries. Dis Colon Rectum 44, 1218–1220 (2001). https://doi.org/10.1007/BF02234648
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DOI: https://doi.org/10.1007/BF02234648