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Decrease in the anorectal pressure gradient after low anterior resection of the rectum. A study using continuous

M E Williamson1, W G Lewis, P J Holdsworth

  • 1Academic Unit of Surgery, General Infirmary at Leeds, United Kingdom.

Diseases of the Colon and Rectum
|December 1, 1994
PubMed
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Low anterior resection (LAR) can cause fecal urgency and leakage due to changes in anorectal function. Increasing neorectal capacity may improve outcomes for patients undergoing LAR.

Area of Science:

  • Colorectal surgery
  • Gastrointestinal physiology
  • Surgical oncology

Background:

  • Low anterior resection (LAR) for rectal cancer can lead to anterior resection syndrome, characterized by defecation urgency and frequency.
  • The mechanisms underlying these functional changes after LAR are not fully understood.
  • Preserving rectal tissue has been suggested to improve outcomes, but the reasons remain unclear.

Purpose of the Study:

  • To investigate the impact of low anterior resection (LAR) on anorectal function.
  • To compare anorectal function in patients after LAR with those who underwent sigmoid colectomy.
  • To elucidate the physiological basis for the anterior resection syndrome.

Main Methods:

  • Continuous ambulatory manometric studies were performed in two groups: patients post-LAR and control patients post-sigmoid colectomy.

Related Experiment Videos

  • Anastomotic levels and anal high-pressure zones were measured.
  • Clinical endpoints including bowel frequency, fecal leakage, and urgency were assessed.

    • Main Results:

    • Patients after LAR exhibited lower resting anal pressures and higher neorectal pressures compared to controls.
    • Anorectal pressure gradients were significantly reduced in the LAR group.
    • Increased bowel frequency, fecal leakage, and urgency were reported in patients following LAR.

    Conclusions:

    • The inferior clinical outcomes after LAR are partly attributed to elevated neorectal pressure affecting a compromised sphincter mechanism.
    • These findings suggest that enhancing neorectal capacity could be beneficial for patients undergoing low anterior resection.
    • Further research into neorectal augmentation strategies is warranted.