What affects continence after anterior resection of the rectum?

Abstract

Functional results after anterior rectal resections are commonly considered satisfactory but variable percentages of postoperative incontinence are often reported. Continence was evaluated after 20 low anterior resections (LAR) and 13 high anterior resections (HAR) by means of clinical assessment, anorectal manometry, and evacuation proctography. Whereas all HAR patients had perfect continence, 10 patients (50 percent of the LAR group had occasional episodes of soiling from liquid feces, 5 patients (25 percent had frequent soiling or occasional incontinence for solid feces, and 1 patient (5 percent had frequent solid stool loss requiring surgical treatment. Anal canal resting pressure at 3 and 4 cm from the anal verge was significantly lower in the LAR group (P less than 0.02 and P less than 0.05, respectively) than in the HAR group. However, the maximum voluntary contraction did not differ between the two groups. Rectoanal inhibitory reflex was found to be present in 17 of the 20 patients with LAR and in all patients with HAR. The volume at which the anal sphincter is continuously inhibited was significantly reduced in the LAR group (P less than 0.001). Also, the conscious rectal sensibility volumes were found to be significantly reduced for threshold, constant, and maximum tolerated volume. Threshold volume for internal sphincter relaxation was lower than the threshold volume for rectal sensation in some patients with LAR. This could allow postoperative fecal soiling. Rectal compliance was decreased (P less than 0.001) in the LAR group. Evacuation proctography, performed in six LAR patients affected by major soiling or solid stool loss, revealed an abnormal obtuse anorectal angle and pathologic lowering of the perineum at rest and during defecation. The concomitance of internal and sphincter impairment, reduction in rectal compliance, and previous pelvis floor muscle damage are postulated as cause affecting continence in patients who underwent LAR.

Survival after surgical treatment of cancer of the rectum

“…Additionally, postoperative quality of life after surgery for rectal cancer appears to be at least similar to that of the average population of the same age [16,43]. This is amazing if one considers the fact that, particularly, surgery in distal rectal cancer, resulting in a low or even colo-anal anastomosis, often leads to deterioration of sphincter function, with faecal incontinence [44][45][46][47][48][49]. Obviously, the impaired functional outcome does not necessarily result in a worse level of global quality of life.…”

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.…”

Anorectal Physiology following Sphincter-Saving Operations for Rectal Cancer

“…4) and. probably, with neorectal compliance [7], This trait was also present in the CAA group (group 3), such as the highest stool frequency and urgency, which had the worst results. They also had rather low MTV.…”