Estimating continence after rectal resection

Aim: To determine clinical and physiologic parameters enabling the prognosi s of continence after protective ileostomy closure secondary to rectal rese ction for rectal cancer. Method: Patients who had undergone rectal resectio n (n = 65, of whom 24 had had radiochemotherapy) were evaluated by clinical examination, anorectal manometry and orthograde contrast enema before ileo stomy closure. Continence was evaluated by clinical findings 91 +/- 52 week s after stoma closure with the help of standardized questionaires and class ified according to the Wexner continence score. The relationship between fi ndings before stoma closure and continence score was calculated with Pearso n's correlation coefficient. Results: Correlations were found to be signifi cant between the continence score and the level of anastomosis (r = -0.58, p < 0.001), median resting pressure (r = -0.52, p < 0.001), rectal complian ce (r = -0.43, p < 0.001). Additionally, radiochemotherapy impairs continen ce (p = 0.0001). Correlations were not significant between continence and f unctional sphincter length, squeeze pressure, threshold for perception, urg e and maximal tolerable volume, and continence for semiliquid contrast medi um. Conclusion: Incontinence after rectum resection is multifactorial: the level of anastomosis, resting pressure, rectal compliance and radiochemothe rapy all play a dominant role. Based on these findings, the continence scor e can be calculated before closure of a diverting ileostomy by applying mul tivariate analysis with the help of the following formula: Continence score = 18.23-0.94 . level of anastomosis - 0.18 . resting pressure + 3.72 . rad iochemotherapy.