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. 2009 Mar;208(3):362-7.
doi: 10.1016/j.jamcollsurg.2008.10.035. Epub 2008 Dec 25.

Evaluation of postoperative damage to anal sphincter/levator ani muscles with three-dimensional vector manometry after sphincter-preserving operation for rectal cancer

Keiji Koda  1 , Hideki Yasuda, Atsushi Hirano, Chihiro Kosugi, Masato Suzuki, Masato Yamazaki, Tohru Tezuka, Ryota Higuchi, Hironori Tsuchiya, Norio Saito
Affiliations

Evaluation of postoperative damage to anal sphincter/levator ani muscles with three-dimensional vector manometry after sphincter-preserving operation for rectal cancer

Keiji Koda et al. J Am Coll Surg. 2009 Mar.

Abstract

Background: The aim of this study was to examine correlations between pressure profile of the anal canal and postoperative defecatory disorder after sphincter-preserving operation (SPO) for rectal cancer.

Study design: Using three-dimensional vector manometry, pressure profile and length of the anal canal were evaluated more than 1 year after SPO according to operation method and degree of postoperative defecatory function in 53 patients with rectal cancer.

Results: Compared with high anterior resection as a control, the anal canal was shorter in operations with a pelvic floor maneuver, namely, low anterior resection, ultra-low anterior resection, and intersphincteric resection. Patients with postoperative defecatory disorder showed significantly shorter anal canal length than patients with fair function. Length of the circular high-pressure zone (> or = 20 mmHg) < 20 mm in the resting state was a strong predictor of severe postoperative defecatory malfunction, with Wexner score> or =10.

Conclusions: Operative maneuvers at the pelvic floor during SPO for rectal cancer may damage anal sphincter or levator ani muscles. The circular high-pressure zone can be measured only by three-dimensional manometry and may offer a useful indicator of sphincter damage after SPO for rectal cancer.

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