Clinical and Physiological Evaluation of Postoperative Defecatory Function after Low Anterior Resection with Colonic J-pouch Reconstruction for Middle and Lower Rectal Cancer

Abstract

The aims of this study were to evaluate postoperative defecatory function after low anterior resection with colonic J-pouch reconstruction for middle or lower rectal cancer and to analyze the relationship of postoperative defecatory function with the results of preoperative and postoperative anorectal physiological study. Clinical assessment using a standard questionnaire about defecatory function, combined with anorectal physiological studies before and after operation were carried out in 31 patients. At 6 and 12 months after operation, mean bowel frequency was 4.3/day and 3.4/day, respectively. The incidence of minor fecal incontinence was 64 % and 58 %, and that of urgency was 45% and 39%. Evacuation difficulty was found in 46% and 24%, respectively. Although maximum basal pressure (MBP) and maximum tolerable volume of the rectum (MTV) significantly decreased at 6 months after operation, those at 12months after operation did not differ from preoperative values. Patients having low postoperative MBP had poor defecatory function. Univariate and multi-variate analysis showed that the risk of postoperative minor incontinence was predictable from patients' age, gender, the extent of pelvic autonomic nerve perservation, preoperative irradiation, and preoperative MBP, rectal sensory threshold, and MTV.