LEVEL OF THE ANASTOMOSIS DOES NOT INFLUENCE FUNCTIONAL OUTCOME AFTER ANTERIOR RECTAL RESECTION FOR RECTAL-CANCER

Anorectal function was studied in 55 patients undergoing low anterior resection for rectal adenocarcinoma, Patients were examined preoperati vely and 3 months postoperatively by anorectal manometry and standardi zed interview, Postoperatively, the patients showed, in general, an im pairment of anorectal functions, After 3 months, continence for flatus was defective, the ability to discriminate natus from feces, and the ability to defer defecation were compromised, Stool frequency was elev ated, and anal resting pressure, squeeze pressure, and rectal complian ce were decreased, The rectoanal inhibitory reflex was abolished in al l patients. However, the two groups with the level of the anastomosis less than or equal to 6 cm (n = 27, range 3 to 6) and more than 6 cm ( n = 28, range 7 to 10) above the anal verge showed no differences in m anometric values, stool frequency, or fecal continence assessed by the interview, No correlation was found between the level of the anastomo sis and manometric values and between the level of the anastomosis and stool frequency (regression analysis = not significant). We concluded that anorectal function after anterior resection and low colorectal a nastomosis are not influenced by tbe remaining length of tile rectum b ut by the surgical trauma to the sphincter and its innervation.