Physiologic status of the anorectum following sphincter-saving resection for carcinoma of the rectum

Abstract

The physiologic status of the anorectum after low anterior resections or pull-through operations of the rectum was evaluated clinically and by manometric studies. The presence of a normal anal resting pressure and an anorectal reflex were important to achieve postoperative continence after sphincter-saving operations. In patients with anastomotic leaks and poor function, a marked high-pressure zone in the anal canal and an anorectal reflex were not found, but as local inflammation resulting from the anastomotic leak disappeared, these parameters returned to normal. A normal anorectal reflex was found in 1 of 3 patients after Bacon-type pull-through operations; the remaining 2 showed an increase of anal canal pressure during colonic distention. An elevation of anal canal pressure in response to colonic distention apparently plays a significant role in fecal continence at the time of a sense of urgency if internal sphincter function is impaired.