CHARACTERIZATION OF DISTAL COLONIC MOTILITY IN EARLY POSTOPERATIVE PERIOD AND EFFECT OF COLONIC ANASTOMOSIS

Under standardized conditions, the manometric motility of the distal c olon following rectosigmoid anastomosis (N = 11, median age 70 years, range 47-80), was compared to that following laparotomies not involvin g colonic anastomosis (N 9, 56 years, 32-65). Microtransducer probes w ere inserted peroperatively and colonic activity recorded continuously (median 96 hr, range 48-109 anastomotic and 75 hr, range 46-107 contr ol group) employing an ambulatory system. Quantitative indices of moti lity were calculated with an automated analysis program. Total postope rative analgesic doses and duration of surgery were similar in both gr oups. The first return in the anastomotic group of isolated waveforms [median 1.8 hr, interquartile range (IQR) 1-3] and propagated waves (9 2 hr, 79-100), was comparable to the control group (4 hr, 1.8-7, and 7 3 hr, 72-101, respectively). Motor complexes, characterized by bursts of regular contractile activity at 3-5 cpm, returned faster in the con trol group (3 hr, 2-24 vs 24 hr, 19-30, P < 0.05). Motility index was significantly depressed during the first 72 hr following surgery in th e anastomotic group compared to controls (P < 0.001). Flatus was passe d at a median of 72 fir (IQR 45-79) in the control and 94 hr (81-105) in the anastomotic group (P = 0.05). The presence of a left-sided colo nic anastomosis has a major inhibitory effect on distal colonic motili ty, compared to nonanastomotic surgery of similar severity, in the ear ly postoperative period.