CORRELATION BETWEEN THE LEVEL OF COLORECTAL ANASTOMOSIS AND ANORECTAL FUNCTION/KORELACIJA IZMEDU RAZINE KOLOREKTALNE ANASTOMOZE I FUNKCIJE ANOREKTUMA

• Published in: Acta clinica Croatica (Tisak) Vol. 59; no. 4; p. 703
• Main Authors: Bakula, Branko, Rasic, Zarko, Jurcic, Dragan, Lucijanic, Marko, Rasic, Fran
• Format: Journal Article
• Language: English
• Published: Klinicki bolnicki centar Sestre milosrdnice 01.12.2020
• Subjects: Care and treatment; Colorectal cancer; Colorectal surgery; Complications and side effects; Development and progression; Diagnosis; Croatia
• ISSN: 0353-9466; 1333-9451
• DOI: 10.20471/acc.2020.59.04.17

Anterior rectal resection is a standard surgical procedure for treating carcinomas of rectum and distal sigmoid colon. In many cases of anterior rectal resection, postoperatively some level of fecal incontinence may occur. The aim of our study was to evaluate the impact of the colorectal anastomosis level on anorectal functional disorder. In our prospective study, the participants were patients diagnosed with carcinoma of rectum or distal sigmoid colon. All patients underwent standard open or laparoscopic anterior rectal resection. Six months after the surgery, the function of anorectum was evaluated in all participants. Finally, 38 patients were analyzed, including 13/38 (34.2%) patients with high rectal anastomosis, 11/38 (28.9%) with mid rectal anastomosis and 14/38 (36.8%) with low rectal anastomosis. Patients with a lower level of anastomosis had a statistically significantly greater number of stools, higher urgency and discrimination impairment, more pronounced solid, liquid and gas incontinence, and greater need for diapers (p<0.05 all). Therefore, patients with lower anastomosis had a statistically significant impairment of their quality of life and higher Wexner score (p<0.001 for both analyses). Our study results suggested reduced neorectal capacity to be the main pathophysiological factor for the development of postoperative anorectal function impairment. Key words: Anterior resection; Rectal cancer; Wexner incontinence score; Anorectal junction Anteriorna resekcija rektuma je standardni operacijski zahvat kod lijecenja karcinoma rektuma i distalnog dijela sigmoidnog kolona. U mnogim slucajevima anteriorne resekcije poslijeoperacijski se pojavljuje odredena razina fekalne inkontinencije. Cilj nase studije bio je istraziti utjecaj visine kolorektalne anastomoze na funkcijski poremecaj anorektuma. Svi ispitanici su podvrgnuti standardnoj otvorenoj ili laparoskopskoj anteriornoj resekciji. Sest mjeseci nakon operacije funkcija anorektuma je evaluirana. Ukupno je analizirano 38 bolesnika, tj. 13/38 (34,2%) s visokom kolorektalnom anastomozom, 11/38 (28,9%) sa srednjom kolorektalnom anastomozom i 14/38 (36,8%) s niskom kolorektalnom anastomozom. Bolesnici s nize postavljenom anastomozom imali su statisticki znacajno veci broj stolica, cesce su imali urgenciju i poremecaj diskriminacije, kao i jace izrazenu krutu, tekucu i inkontinenciju plinova, cesce su trebali pelene (p<0,05 za sve navedene analize). Sukladno tome, bolesnici s nize postavljenom anastomozom imali su statisticki znacajno jace narusenu kvalitetu zivota i visi Wexnerov zbir (p<0,001 za obje analize). Misljenja smo da je smanjeni kapacitet neorektuma glavni patofizioloski cimbenik za razvoj poslijeoperacijskog funkcijskog poremecaja anorektuma. Kljucne rijeci: Anteriorna resekcija; Karcinom rektuma; Wexnerov bodovni sustav; Funkcija anorektuma