FACTORS INFLUENCING BOWEL FUNCTION FOLLOWING TOTAL ABDOMINAL COLECTOMY

PURPOSE: The purpose of this study was to determine which factors infl uenced bowel function following total abdominal colectomy. METHODS: Th irty-two patients who had undergone total abdominal colectomy were stu died with regard to factors that are classically thought to influence bowel function, namely, residual stump length, transit time, and recta l stump manometry. In a limited subset of patients, anal manometry was done also. RESULTS: Transit time was the best predictor of bower func tion following total abdominal colectomy. This was followed by stump l ength. If transit time was short, then stump length became important i n predicting the occurrence of diarrhea following total abdominal cole ctomy. CONCLUSIONS: Two factors have an important influence on bowel f unction following total abdominal colectomy: transit time and rectal s tump length. Rectal stump length is an anatomic factor that can be con trolled by the surgeon. In total abdominal colectomy, rectal stump len gth of at least 20 cm is necessary if the patient is to have satisfact ory postoperative bowel function. This may not always be possible. In these patients, modification of diet to influence transit time and met hods to increase rectal compliance will be necessary.