Anastomotic leakage and functional outcome after anterior resection of the rectum

Nineteen patients with symptomatic anastomotic leakage after anterior resection were compared with 19 without leakage. The two groups were closely matched according to age, sex, height of anastomosis and follow-up. No patient had any sign of anastomotic stricture or neoplastic recurrence at the time of the study. After a median of 30 (range 12-87) months there was no difference in sphincter function as measured by manometry. 'Neorectal' volume at distension pressures of 40 and 50 cmH2O and compliance at sensation of filling, urge to defaecate and maximum tolerated volume were significantly reduced in patients with leakage. This reduction in neorectal reservoir function was reflected in impaired anorectal function, measured by a combination of: (1) frequency of bowel movements; (2) degree of urgency; (3) incontinence score; and (4) degree of impaired evacuation. Long-term functional outcome may be impaired by anastomotic leakage.