Intestinal Contents Stayed After Discharge as Low Anterior Resection Syndrome

Abstract

Background: The lower anastomosis after low anterior resection (LAR) is associated with the development of low anterior resection syndrome (LARS). However, pathophysiology of fragmentation of defecation which is one of LARS remains unknown. Patients and Methods: Between January 2015 and December 2017, eight patients with temporary ileostomy who underwent LAR with double stapling technique (DST) for rectal cancer at our hospital were studied. As the control group, nine patients with temporary ileostomy who underwent proctocolectomy (PC) with DST for ulcerative colitis in the same period were recruited. Defecography was performed two weeks after closure of the ileostomy. The defecation of all patients was evaluated by defecography. Results: In all patients, the descent of the perineum and linearization of the anorectal angle were observed. In patients after PC, all barium could be discharged by some abdominal pressures. On the other hand, in all patients after LAR, barium located anal to the anastomosis could be discharged through the anus, while barium located oral to the anastomosis stayed after discharge, which could not be expelled by maximal abdominal pressures more than 5 minutes after starting evaluation. Conclusion: Remnant intestinal contents after defecation seems to be one of disturbance for defecation after LAR.