Defecographic Assessment after Sigmoidectomy or Anterior Resection of Rectum

Mitsunobu Kikuchi

The Second Department of Surgery, Yokohama City University, School of Medicine

Twenty four patients were involved in a study on defecation function of the patients undergoing sigmoidectomy or anterior resection of the rectum. Clinical bowel function was determined from the point of frequency of defecation and soiling. Defecography was performed in 24 patients with anterior resection of rectum or sigmoidectomy. There was an inverse correlation between anastomoses situated above the peritoneal reflex and bowel movement (p<0.01). The anastomotic sites of seven patients who suffered from soiling were all within 1 cm above the anal canal. There were no difference between the anorectal angle and perineal descent atrest, during squeezing and straining before and post operation. Rectal emptying ratio after the operation was significantly lower than that before the operation. There was an inverse correlation between the rectal emptying ratio and bowel movement 1 year after operation (p<0.05). The rectal emptying ratio was 66±35% in the patients without soiling, 38±30% in the patients with soiling. Videodefecography revealed that barium below the anastomosis was evacuated, but barium above the anastomosis remained in the colon. Therefore, poor rectal emptying was mainly due to poor rectal emptying of the contents above the site of anastomosis. After self-irrigation of the colon, defecation disorders such as analgia, perianal redness, sleeplessness and soiling improved in all patients. In conclusion, increase of bowel movement after sigmoidectomy or anterior resection of rectym, was due to poor emptying of the rectum, especially above the site of the anastomosis.

Key words
defecography, anterior resection of rectum, sigmoidectomy, soiling, bowel frequency

Reprint requests
Mitsunobu Kikuchi The Second Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0005 JAPAN

Accepted
January 26, 2000

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