Usefulness of Fecoflowgram for Assessment of Defecation after Intersphincteric Resection

Abstract

Aim: We have developed an imaging functional assessment of defecation after partial intersphincteric resection (ISR) by fecoflowgram obtained by defecography. Patients and Methods: Between January 2012 and December 2014, 6 patients with temporary ileostomy who underwent partial ISR for lower rectal cancer at our hospital were enrolled in this study. Defecography was performed 2 weeks after closure of the ileostomy. The defecation of all patients was evaluated by defecography and a fecoflowgram calculated from defecography. During the same period, the control group was comprised of 2 male and 2 female healthy volunteers. Results: The descent of the perineum and linearization of the anorectal angle was observed relative to normal defecation in the healthy volunteers. All barium was discharged by a single abdominal pressure within 5 s in the controls. In patients after partial ISR, all barium could not be discharged by a single abdominal pressure. The time course of pressure distribution after ISR was lower than that of healthy volunteers, which could not be evaluated by defecography. Defecation time in patients following ISR was longer than that of healthy volunteers. Conclusion: Fecoflowgrams calculated from defecography seem to be useful for functional assessment of defecation after rectal resection.

Latest Advances in Intersphincteric Resection for Low Rectal Cancer

“…Kitaguchi et al [ 85 ] found that maximum resting pressure and maximum squeeze pressure were significantly lower after ISR, and an elevated incidence of severe FI after ISR was independently related to a high pressure zone before ISR ≤ 3 cm and MRP before ISR > 60 mmHg. Lately, the fecoflowgrams calculated from defecography has also been a promising assessment of defecation after ISR [ 86 ]. Functional results after ISR reported by several studies [ 7 , 11 , 60 , 80 , 87 – 99 ] have been summarized in Tables 3 and 4 .…”

“…High-resolution anorectal manometry (HR-ARM) is reliable for the evaluation of anal function after ISR objectively and accurately, and the high pressure zone and maximum resting pressure (MRP) may be useful [85] found that maximum resting pressure and maximum squeeze pressure were significantly lower after ISR, and an elevated incidence of severe FI after ISR was independently related to a high pressure zone before ISR ≤ 3 cm and MRP before ISR > 60 mmHg. Lately, the fecoflowgrams calculated from defecography has also been a promising assessment of defecation after ISR [86]. Functional results after ISR reported by several studies [7,11,60,80,[87][88][89][90][91][92][93][94][95][96][97][98][99] have been summarized in Tables 3 and 4.…”

Intestinal Contents Stayed After Discharge as Low Anterior Resection Syndrome

“…Defecational functions consist of two main factors. One is motional function, which is evaluated by defecography, and the other is time course of pressure distribution during defecation which is evaluated by fecoflowgram [11].…”