Summary
The effect of coloanal anastomosis (CAA) on the function of the anal sphincters was assessed in 27 cases by interview, sphincter manometry and a retention test. During an observation period of 3–12 months after closure of colostomy, the percentage of patients with perfect continence increased from 50 to 80%, of those with solid stool consistency from 30 to 90% and of those with solid stool consisteny from 30 to 90% and of those with less than 5 b.o./day from 30 to 80%. The operation resulted in a significant reduction of the length of the anal canal from 4.0 ± 0.3 to 1.7 ± 0.2 cm (P < 0.001) and a significant reduction of the resting tone from 85.5 ± 7.9 to 30.3 ± 6.1 cm H2O (P < 0.001). The contraction pressure was hardly influenced, the recto-anal inhibition reflex was temporarily lost. Minute preoperative assessment of a normal sphincter function with anal manometry is an essential prerequisite for the evaluation of the indication for a CAA.
Zusammenfassung
Die Sphincterfunktion nach coloanaler Anastomose wurde in 27 Fällen durch Kontinenzanamnese, Sphinctermanometrie und Retentionstest untersucht. In einem Beobachtungszeitraum von 3 bis 12 Monaten nach dem Colostomieverschluß stieg der Anteil von Patienten mit vollständiger Kontinenz von 50 auf 80%, von jenen mit fester Stuhlkonsistenz von 30 auf 90% und von jenen mit weniger als 5 Defäkationen/Tag von 30 auf 80%. Die Operation bewirkte eine signifikante Verkürzung des Analkanals von 4,0 ± 0,3 auf 1,7 ± 0,2 cm (p < 0,001) und eine signifikante Reduktion des Ruhedrucks von 85,5 ± 7,9 auf 30,3 ± 6,1 cm H2O (p < 0,001). Der Kontraktionsdruck wurde nicht wesentlich beeinträchtigt, der rectoanale Reflex ging temporär verloren. Wesentliche Voraussetzung zur Indikationsstellung der KAA ist eine durch präoperative Sphincterdiagnostik objektivierte normale Funktion des analen Schließmuskelapparates.
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Wunderlich, M., Teleky, B. & Schiessel, R. Sphincterfunktion nach coloanaler Anastomose. Langenbecks Arch Chiv 367, 259–269 (1986). https://doi.org/10.1007/BF01263406
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DOI: https://doi.org/10.1007/BF01263406