Clinical and manometric evaluation of anorectal function following low anterior resection with low anastomotic line using an EEA™ stapler for rectal cancer

Abstract

Anorectal function was evaluated in eight patients who had low anterior resection of the rectum with a low anastomotic line, using an EEA stapler, with determination of function based on periodic manometric studies and clinical symptoms. Immediately following surgery all patients suffered from frequent bowel actions and soiling. These symptoms improved with time and most patients could enjoy almost normal daily life by the sixth postoperative month. One month after surgery, anal canal resting pressure and maximum squeeze pressure were significantly reduced and rectoanal inhibitory reflex was absent; neither showed a distinct tendency to improve thereafter. Rectal sensation and reservoir capacity, which also were seriously impaired, recovered satisfactorily by the time of the six-month examination. This suggests that an improvement of clinical symptoms following this operation is dependent upon the recovery of reservoir capacity and sensation of the neorectum, and that this operative procedure is a functionally acceptable option for low rectal cancer.

Iatrogenic colorectal perforation induced by anorectal manometry: Report of two cases after restorative proctectomy for distal rectal cancer

“…Anorectal manometry has been widely adopted as a means for evaluating physiological changes in the anus and rectum of patients undergoing low anterior resection. To our knowledge, no iatrogenic perforation has been reported as a complication arising from anorectal manometry conducted following low anterior resection [3,[5][6][7] . We consider that this colorectal perforation is associated with certain characteristics of the neorectum following low anterior resection and anastomosis, including relative weakening of the proximal bowel wall due to anastomosis, decreased compliance, and abnormal rectal sensation.…”

“…His heart rate was 110 per minute and no hypotension was found. The most noteworthy feature of his laboratory studies was an elevated white blood cell count of 17 000/ mm 3 . Upright chest and abdomen films were normal.…”

“…Currently, anorectal manometry is widely performed for the tracking of anorectal physiological changes occurring after low anterior resection for rectal cancer, as the test allows for a numerical value evaluation of pre-and post-operative anorectal function, including rectoanal inhibitory reflex, rectal compliance, and anal resting pressure [2][3][4] . This procedure is generally thought to be safe, and the incidence of critical complications associated with anorectal manometry has not been reported.…”

Câncer ano-reto-cólico: aspectos atuais v - câncer de reto: tratamento cirúrgico

“…Em geral são anastomoses que estão mais ou menos a 6 cm da borda anal 85 , confeccionada em área de isquemia relativa. Outro fator relevante, provavelmente associado ao uso de grampeador, ocorre no duplo grampeamento distal do reto em que a segunda fileira (a mais distal) de grampos é disparada de 0,5 a 1 cm da linha pectínea, pegando e danificando parte da musculatura do anel anorretal que faz parte do complexo esfincteriano, o que certamente contribuirá para os distúrbios funcionais do esfíncter anal 55 observados em números significativos, comprometendo de 13 a 80% dos pacientes [86][87][88] e, também, para imperfeições na junção das "bocas" anastomosadas. Nesse local, damos preferência para anastomose confeccionada à mão, por via anal, que, dependendo da extensão de reto que fica acima da linha pectínea, um anel de até 1 cm de mucosa pode ser facilmente retirado para que o cólon seja "abaixado" por dentro do anel muscular, onde se procede com a anastomose com pontos separados envolvendo a mucosa e a parede muscular anorretal e toda a espessura do cólon.…”

Anorectal Physiology following Sphincter-Saving Operations for Rectal Cancer

“…Groups 1, 2 and 3 underwent these procedures at least 6 months after surgery [3]. Stool frequency referred to diurnal and nocturnal periods.…”