[Sphincter function after rectal resection with peranal anastomosis (author's transl)]

Intersphincteric resection for low rectal tumours

An abdominoperineal operation is described that extends rectal resection for low tumours into the intersphincteric plane with removal of the internal sphincter. Bowel continuity is restored by coloanal anastomosis. Of 38 patients who underwent surgery since 1984, 34 had low rectal cancer and four carcinoid or large villous adenoma. There was no mortality. Four patients developed local recurrence during a median observation period of 3 years. Continence was satisfactory in all patients. The median daily number of bowel movements during the first months after colostomy closure was 9 but decreased to 3 after 1 year and 1 after 2 years. Anal manometry demonstrated a significant reduction of mean resting pressure from 91.8 to 35.1 cmH2O with no recovery after 2 years (P < 0.0001). Squeeze pressure showed only a transient decrease.

[Sphincter function following colo-anal anastomosis]

The effect of colo-anal 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 consistency 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 less than 0.001) and a significant reduction of the resting tone from 85.5 +/- 7.9 to 30.3 +/- 6.1 cm H2O (p less than 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.

[The abdominoendorectal resection with peranal anastomosis in the treatment of radiation injuries of the rectum (author's transl)]

During the period 1974-1980 39 patients underwent operations at the Prosper Hospital in Recklinghausen for radiation injuries to the rectum or rectosigmoid. They comprised 22 patients with rectovaginal fistulas, 6 with ulcers, 3 suffering from severe hemorrhagic proctitis, 5 with rectal strictures, 1 with necrosis, and 2 with radiation ulcers and carcinoma. A sphincter-saving operative method of treating postirradiation damage of the rectum is presented. The technique involves the peranal anastomosis of healthy colon to the midanal canal using a sleeve anastomosis. Technical and functional results of resectional surgery for the rectal complications of radiation therapy are reported. Subjectively, total continence was present in 78%, only 1 patient was incontinent because of flatus and watery stools.