Sigmoid motility and clinical results after transverse taeniamyotomy for diverticular disease

Abstract

SUMMARYThe purpose of our DIVERTICULAR disease of the colon is a common condition in western countries and its frequency is increasing (Painter, 1972). A post-mortem survey has shown colonic diverticula in 43 per cent of people of 50 years or more; and of patients with the disease, the sigmoid is affected in 99 per cent (Hughes, 1969). Morson (1963) described a complete absence of any inflammation in one-third of 173 resected specimens from patients operated on for a clinical picture of diverticulitis at St Mark's Hospital. Thickened and shortened taeniae were noted and circular muscle seemed to be hypertrophic and corrugated.These muscular lesions, which represent the primary disorder of the disease, do not depend on smooth muscle hyperplasia but on a spasm caused by taeniae shortening, which becomes permanent as the thickened muscle behaves like a myostatic contracture (Williams, 1965). The consequent plication of the circular layer narrows the lumen, thus increasing the intraluminal pressure according to Laplace's law. The resulting hypersegmentation is thought to be important in the pathogenesis of the diverticula (Painter, 1967).For the treatment of this motor disorder, Arfwidsson (1964) suggested a transverse section of the shortened taeniae; the lengthening effect should reduce the circular layer plication and the consequent widening of the lumen should normalize motility. Johnson (1972) observed the effect of sectioning the two antimesenteric taeniae in the rabbit; he called the operation 'transverse taeniamyotomy', and it has been used on man with good results (Hodgson, 1974).We operated by this technique on a group of patients affected by symptomatic diverticular disease. The purpose of our investigation was to assess the effect of transverse taeniamyotomy on the clinical picture and on the rectosigmoid motor activity of these subjects 1 year after surgery. Patients and methodsTwelve patients affected by symptomatic, uncomplicated diverticular disease of the sigmoid were selected for the operation after the failure of antispasmodics, high residue diet and bran as medical therapy. Eight of them (4 males and 4 females, average age 59 years) were followed up for a period of at least 1 year and could therefore be considered in this study.For transverse taeniamyotomy we used the technique described by Hodgson (1973). The abdomen was opened through a left paramedian incision and, after mobilization of the rectosigmoid junction, multiple transverse sections of the antimesenteric taeniae were made; only the longitudinal layer was divided and the bleeding was controlled by using small swabs imbued with adrenaline (diathermy could perforate the bowel). We divided the taeniae of the distal colon which were affected by muscular thickness. The two extreme limits of the transverse taeniamyotorny were marked by radio-opaque clips for postoperative radiomanometric control. Routine drainage was not undertaken. High residue diet and bran were prescribed after transverse taeniamyotomy.