Defecation Status Research Articles

Effect of Gum Chewing on Intestinal Functions after Gynecological Operations: A Randomized Controlled Study

OBJECTIVE: We aimed to assess the efficacy of gum chewing on intestinal functions after gynecological operations.STUDY DESIGN: A total of 86 women who underwent gynecological operation with different indications were randomly assigned to 2 groups: Group 1 was assigned to gum chewing after operation (n=52), while Group 2 was directed to routine postoperative care (n=52). Time of first bowel sound and defecation after surgery were recorded to assess the effect of gum chewing. Operation time, blood loss, type of incision, pre and postoperative serum hemoglobin levels were all evaluated.RESULTS: There was no difference between groups in terms of age, duration of operation, intraoperative blood loss, pre and postoperative serum hemoglobin levels, duration to first bowel sound, flatulence and defecation (p>0.05). Age (r=0.234, p=0.032), type of incision (r=0.228, p=0.037) were significantly correlated with the time to first bowel sound. Type of incision (r=0.295, p=0.006), duration of operation (r=0.277, p=0.01) and intraoperative blood loss (r=0.298, p=0.006) were significantly correlated with the time to first flatulence. In multivariate regression analyses, none of the variables were found to be significant parameter for time to first bowel sound (p>0.05). CONCLUSION: Gum chewing does not affect some of the gastrointestinal functions after gynecological operations and there is no single parameter for time to first bowel sound, first flatulence and first defecation, individual surgical and medical condition differences should be kept in mind while evaluating intestinal functions.

Actual Defecation Conditions and Factors Related to Diarrhea among Elderly Individuals Receiving Tube Feeding in a Recuperation Ward

Actual Defecation Conditions and Factors Related to Diarrhea among Elderly Individuals Receiving Tube Feeding in a Recuperation Ward

Therapeutic effects of Lactobacillus casei Qian treatment in activated carbon-induced constipated mice.

In the present study, the therapeutic effects of Lactobacillus casei Qian (LC-Qian), the key microorganism in Tibetan yak yoghurt, on activated carbon-induced constipation were determined in vivo. ICR mice were treated with LC-Qian for nine days by oral administration. The body weight, defecation status, gastrointestinal transit and defecation time of mice were assessed, and the serum levels of motilin (MTL), gastrin (Gas), endothelin (ET), somatostatin (SS), acetylcholinesterase (AChE), substance P (SP) and vasoactive intestinal peptide (VIP) were further evaluated. Bisacodyl was used as the positive control. The time until the first black stool defecation following carbon intake of the normal, control, 100 mg/kg bisacodyl-treated, Lactobacillus bulgaricus (LB)-treated, LC-Qian (L)-and LC-Qian (H)-treated mice was 93, 231, 121, 194, 172 and 157 min, respectively. Following treatment with LC-Qian, the gastrointestinal transit was increased to 52.4% [LC-Qian (L)] and 65.8% [LC-Qian (H)], while that in the group treated with the common lactic acid bacteria of LB was 40.3%. The MTL, Gas, ET, AChE, SP and VIP serum levels were significantly increased and levels of SS were reduced in mice following LC-Qian treatment compared with those in the control mice (P<0.05). Reverse transcription quantitative polymerase chain reaction indicated that LC-Qian raised the c-Kit, GDNF as well as SCF mRNA expression levels and reduced the TRPV1 and NOS expression levels in tissue of the small intestine in mice. These results suggested that lactic acid bacteria prevent constipation in mice, among which LC-Qian was the most effective.

Preventive effect of Dendrobium candidum Wall. ex Lindl. on activated carbon-induced constipation in mice.

The aim of this study was to investigate the effects of Dendrobium candidum Wall. ex Lindl. (D. candidum) on activated carbon-induced constipation in ICR mice. ICR mice were orally administered D. candidum for 9 days. Body weight, defecation status, gastrointestinal (GI) transit and defecation times, in addition to the levels of motilin (MTL), gastrin (Gas), endothelin (ET), somatostatin (SS), acetylcholinesterase (AChE), substance P (SP) and vasoactive intestinal peptide (VIP) in serum were used to evaluate the preventive effects of D. candidum on constipation. The laxative drug bisacodyl acted as a positive control. The time to the first defecation of a black stool for the normal, control, bisacodyl-treated (100 mg/kg), 200 and 400 mg/kg D. candidum-treated mice was 84, 202, 126, 161 and 142 min, respectively. Following the consumption of 200 and 400 mg/kg D. candidum or bisacodyl (100 mg/kg), the GI transit was reduced to 57.7, 74.6 and 90.2%, respectively, of the transit in normal mice. The serum levels of MTL, Gas, ET, AChE, SP and VIP were significantly increased and the serum levels of SS were reduced in the mice treated with D. candidum compared with those in the untreated control mice (P<0.05). These results demonstrate that D. candidum has preventive effects on constipation in mice, and a greater functional activity was observed when a higher concentration was administered.

Therapeutic effect of activated carbon-induced constipation mice with Lactobacillus fermentum Suo on treatment.

The aim of this study was to investigate the effects of Lactobacillus fermentum Suo (LF-Suo) on activated carbon-induced constipation in ICR (Institute of Cancer Research) mice. ICR mice were orally administered with lactic acid bacteria for 9 days. Body weight, diet intake, drinking amount, defecation status, gastrointestinal transit and defecation time, and the serum levels of MTL (motilin), Gas (gastrin), ET (endothelin), SS (somatostatin), AChE (acetylcholinesterase), SP (substance P), VIP (vasoactive intestinal peptide) were used to evaluate the preventive effects of LF-Suo on constipation. Bisacodyl, a laxative drug, was used as a positive control. The normal, control, 100 mg/kg bisacodyl treatment, LB (Lactobacillus bulgaricus)-, LF-Suo (L)- and LF-Suo (H)-treated mice showed the time to the first black stool defecation at 90, 218, 117, 180, 155 and 137 min, respectively. By the oral administration of LB-, LF-Suo (L), LF-Suo (H) or bisacodyl (100 mg/kg), the gastrointestinal transit was reduced to 55.2%, 72.3%, 85.5% and 94.6%, respectively, of the transit in normal mice, respectively. In contrast to the control mice, the serum levels of MTL, Gas, ET, AChE, SP and VIP were significantly increased and the serum levels of SS were reduced in the mice treated with LF-Suo (p < 0.05). By the RT-PCR (reverse transcription–polymerase chain reaction) and western blot assays, LF-Suo increased the c-Kit, SCF (stem cell factor), GDNF (glial cell line-derived neurotrophic factor) and decreased TRPV1 (transient receptor potential vanilloid 1), NOS (nitric oxide synthase) expressions of small intestine tissue in mice. These results demonstrate that lactic acid bacteria has preventive effects on mouse constipation and LF-Suo demonstrated the best functional activity.

Preventive effect of Lactobacillus fermentum Lee on activated carbon-induced constipation in mice.

The aim of this study was to investigate the effects of Lactobacillus fermentum Lee (LF-Lee) on activated carbon-induced constipation in ICR mice. ICR mice were orally administered lactic acid bacteria for nine days. Body weight, dietary and water intake, defecation status, gastrointestinal (GI) transit and defecation time, as well as levels of motilin (MTL), gastrin (Gas), endothelin (ET), somatostatin (SS), acetylcholinesterase (AChE), substance P (SP) and vasoactive intestinal peptide (VIP) in serum were measured to evaluate the preventive effects of LF-Lee on constipation. Bisacodyl, a laxative drug, was administered as a positive control. The time taken until the first defecation of a black stool for normal, control, bisacodyl- (100 mg/kg, oral administration), Lactobacillus bulgaricus (LB)-, LF-Lee low dose (L)- and LF-Lee high dose (H)-treated mice was 90, 218, 117, 180, 161 and 151 min, respectively. Following the consumption of LB, LF-Lee (L) or LF-Lee (H), or the oral administration of bisacodyl, the GI transit was reduced to 55.2, 65.8, 73.1 and 94.6%, respectively, of the transit in normal mice. The serum levels of MTL, Gas, ET, AChE, SP and VIP were significantly increased and those of SS were reduced in the mice treated with LF-Lee compared with those in the untreated control mice (P<0.05). These results demonstrate that lactic acid bacteria have preventive effects on constipation in mice and that LF-Lee has superior functional activity.

Preventive effect of polysaccharide of Larimichthys Crocea swimming bladder on activated carbon-induced constipation in mice

Effects of polysaccharide of Larimichthys crocea swimming bladder (PLCSB) on activated carbon-induced constipation in ICR mice were investigated. ICR mice were subjected to oral administration with lactic acid bacteria for 9 days. Body weight, diet and drinking intake, defecation status, gastrointestinal transit, and defecation time, as well as motilin (MTL), gastrin (Gas), endothelin (ET), somatostatin (SS), acetylcholinesterase (AChE), substance P (SP), and vasoactive intestinal peptide (VIP) levels in serum were used to evaluate the preventive effects of PLCSB on constipation. Bisacodyl, a laxative drug, was used as a positive control. The time to the first black stool defecation for normal, control, bisacodyl-treated (100 mg/kg), 50 and 100 mg/kg PLCSB-treated mice were 88, 202, 126, 155, and 135 min, respectively. Following the consumption of oral administration of 50 and 100 mg/kg PLCSB or bisacodyl (100 mg/kg), the gastrointestinal transit was reduced to 62.6, 78.3, and 90.2%, respectively. The serum levels of MTL, Gas, ET, AChE, SP, and VIP were significantly increased, and the serum levels of SS were reduced in the mice treated with PLCSB compared with those in the untreated control mice (p <0.05). These results demonstrate that PLCSB has preventive effects on mouse constipation and high concentration of that demonstrated the better functional activity.

현미-채식 식단 프로그램이 고등학생의 배변상태와 건강상태에 미치는 효과

Purpose: This study was conducted to evaluate the effects of a brown rice and vegetable dietary program on the defecation conditions and health status of high school students. Method: A non-equivalent control group and pretest-posttest design was used. The subjects were 62 students (28 in the intervention group, 34 in the control group) who voluntarily participated in the study. The program was conducted from April 6, 2012 to July 3, 2012 at two high schools in Daegu city. During that time, two meals a day were supplied to the experimental group. Data on defecation condition and health status was collected using self-questionnaires. Results: After 12 weeks, students in the intervention group had a significantly better defecation condition than students in the control group. Students in the intervention group also had a significantly higher health status than students in the control group. Conclusion: The results suggest that a brown rice and vegetable dietary program improves the defecation condition and health status of high school students. Therefore, the development and study of nursing intervention and public health education program about brown rice as well as vegetable and fresh fruit consumption are necessary for these subjects.

Sacral neuromodulation for fecal incontinence and “low anterior resection syndrome” following neoadjuvant therapy for rectal cancer

It was the aim of this prospective study to analyze both feasibility and effectiveness of sacral neuromodulation for fecal incontinence and "low anterior resection syndrome" following neoadjuvant therapy for rectal cancer. All patients who underwent sacral neuromdulation following neoadjuvant therapy for rectal cancer (preoperative radiochemotherapy, oncologic rectal resection with total mesorectal excision) were prospectively enrolled in the study. Only patients with failure of conservative treatment and without any evidence of residual or recurrent tumor disease were candidates for sacral neuromdulation which was performed by a two-stage procedure (diagnostic percutaneous test stimulation followed by definite implant). In addition to feasibility, primary end points included success (reduction of incontinent episodes), continence and defecation status (assessed by Cleveland Clinic Incontinence Score and Altomare score), and quality of life (EQ-5D). Anal manometry was performed preoperative and at 12-month follow-up. Follow-up information was derived from clinical examination 3, 6, and 12 months postoperatively. Nine patients (three females, six males) with a mean age of 61 years underwent sacral neuromodulation following neoadjuvant therapy for rectal cancer. Implantation rate was 100 %. No septic morbidity was observed. After a mean follow-up of 12 months, mean Cleveland Clinic Incontinence Score was reduced from 18.2 to 6.0 (p < 0.01). Incontinence episodes were significantly reduced from 7 to 0.5 (per day) and 20 to 8 (per week). Fecal urgency, fragmented defecation, and soiling were improved or resolved in two thirds. Altomare score was significantly reduced from 21.0 to 9.3 (p < 0.01). Anorectal manometry did not correlate with clinical success. Quality of life was significantly improved (EQ-5D generic: 0.42 vs. 0.74, EQ-5D-VAS score: 20 vs. 90, p < 0.01). Preliminary results of sacral neuromodulation in patients with fecal incontinence and symptoms of "low anterior resection syndrome" are promising and enrich the therapeutic modalities if conservative management has failed.

Influence of fiberform on defecation condition after surgery for benign anorectal lesion

To explore the influence of fiberform on the defecation condition after surgery for benign anorectal lesion. A total of 121 cases undergoing surgery for benign anorectal lesion at the Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from October 2009 to February 2010 were randomly divided into the treatment group (n=61) and the control group (n=60) according to random number table. Patients in the treatment group received fiberform granule for 2 weeks while patients in the control group did not receive any medication to promote defecation. Postoperative defecation symptom scores and patient satisfaction were compared between the two groups. On postoperative day 7, patients in the treatment group had a lower defecation smoothness score (62.1% decrease), lower fecal character score (74.3% decrease), lower defecation interval score (80.2% decrease), lower defecation pain score (77.5% decrease), the differences were statistically significant. On postoperative day 14, the degree of decrease of the abovementioned score were 58.3%, 88.5%, 82.8% and 83.1%, respectively. Postoperative patient satisfaction rate in the treatment group was significantly higher than that in the control group(P<0.05). No patient in the treatment group experienced any adverse events such as abdominal pain, diarrhea, and drug dependence. Fiberform can effectively prevent defecation disorders such as dry stool, unsmooth defecation, and anorectal pain.

Application of prospective nursing in preventing constipation of patients with acute myocardial infarction

Objective To explore the effect of prospective nursing on preventing constipation for patients with acute myocardial infarction(AMI). Methods 43 AMI patients during July 2008 and June 2010 in our hospital were classified as the observation group, besides the nursing routine of the acute myocardial infarction plus routine therapy to prevent constipation, prospective nursing was implemented.Through the retrospective analysis of medical record, 41 of AMI in our hospital during March 2006 and June 2008 were classified as the control group, they were given the nursing routine of the acute myocardial infarction plus routine therapy to prevent constipation and the nursing intervention after occurrence of constipation. The defecation condition was assessed for the two groups of patients on admission and the defecation and mortality rate was compared on the eighth day of hospitalization. Results There was significant difference in constipation and mortality rate between the two groups of patients during hospitalization. Conclusions The prospective nursing for AMI patients to prevent constipation can obviously reduce the incidence of constipation, thus to avoid serious complications caused by constipation and reduce mortality. Key words: Prospective nursing; Prevention; Myocardial infarction; Constipation

Lavements évacuateurs

Transanal irrigation is an old procedure-using enema to control constipation and defecation disorders. This method, however, has new developments to achieve continence and defecation status in subject with neurologic disorders. In such a condition, rectal balloon and single use devices are helpful in self administered conditions.

Effect of a fermented milk containing Bifidobacterium lactis DN-173010 on Chinese constipated women

To investigate the effect of a fermented milk containing Bifidobacterium lactis DN-173010 and yogurt strains (BIO(R)) on adult women with constipation in Beijing. A total of 135 adult females with constipation were randomly allocated to consume for 2 wk either 100 g of the test fermented milk or 100 g of an acidified milk containing non-living bacteria (control). Stool frequency, defecation condition scores, stool consistency and food intake were recorded at baseline and after 1 and 2 wk in an intention-to-treat population of 126 subjects. In parallel, safety evaluation parameters were performed. At baseline, no differences were found between groups. Following consumption of test product, stool frequency was significantly increased after 1 wk (3.5 +/- 1.5 vs 2.4 +/- 0.6, P < 0.01) and 2 wk (4.1 +/- 1.7 vs 2.4 +/- 0.6, P < 0.01), vs baseline. Similarly, after 1 and 2 wk, of test product consumption, defecation condition (1.1 +/- 0.9 vs 1.9 +/- 1.2, P < 0.01 and 0.8 +/- 1.0 vs 1.9 +/- 1.2, P < 0.01, respectively) and stool consistency (1.0 +/- 0.8 vs 1.5 +/- 1.1, P < 0.01 and 0.6 +/- 0.8 vs 1.5 +/- 1.1, P < 0.01, respectively) were significantly improved. Compared with the control group, stool frequency was also significantly increased (3.5 +/- 1.5 vs 2.5 +/- 0.9, P < 0.01 and 4.1 +/- 1.7 vs 2.6 +/- 1.0, P < 0.01, respectively), and defecation condition (1.1 +/- 0.9 vs 1.6 +/- 1.1, P < 0.01 and 0.8 +/- 1.0 vs 1.6 +/- 1.1, P < 0.01, respectively) and stool consistency (1.0 +/- 0.8 vs 1.4 +/- 1.0, P < 0.05 and 0.6 +/- 0.8 vs 1.3 +/- 1.0, P < 0.01, respectively) significantly decreased after 1 and 2 wk of product consumption. During the same period, food intake did not change between the two groups, and safety parameters of the subjects were within normal ranges. This study suggests a beneficial effect of a fermented milk containing B. lactis DN-173010 on stool frequency, defecation condition and stool consistency in adult women with constipation constipated women after 1 and 2 wk of consumption.

Factors Affecting the Bowel Function after Proctocolectomy and Ileal J Pouch–Anal Anastomosis for Ulcerative Colitis

The aim was to study determinants of postoperative bowel function after restorative proctocolectomy for ulcerative colitis. Medical records of patients who underwent proctocolectomy with ileal J pouch-anal anastomosis (IPAA) in two- or three-stage operations and whose status of defecation was known via a questionnaire were retrospectively reviewed. Bowel function, including stool frequency, stool consistency, and degree of nighttime soiling, was correlated with age at the time of surgery, time after ileostomy closure, mean resting anal pressure, longitudinal length of ileal J pouch, and duration of fecal diversion by using univariate and multivariate analyses. Stool frequency decreased significantly with time after ileostomy closure in both univariate and multivariate analyses. Stool frequency tended to be less in patients having a long J pouch, but the correlation was not significant (P = 0.071) in univariate analysis. Nighttime soiling ameliorated with time after ileostomy closure in multivariate, but not univariate, analysis. Deterioration of nighttime soiling was seen in patients whose duration for fecal diversion was long, both in univariate (P = 0.068) and multivariate (P = 0.052) analyses. Stool consistency was related to none of the five factors investigated. These results indicate that as the time after surgery increases, stool frequency decreases and nighttime soiling ameliorates. Delaying ileostomy closure because of anticipated postoperative incontinence does not significantly alter postoperative continence.

Pelvic Organ Prolapse in Defecatory Disorders

To compare the prevalence of pelvic organ prolapse in subjects with defecatory disorders with that in control subjects. In 55 subjects with fecal incontinence, 42 subjects with obstructed defecation, and 45 healthy subjects without defecatory symptoms, a urogynecologist assessed pelvic organ prolapse by the pelvic organ prolapse quantification system, and a gastroenterologist evaluated perineal descent during simulated evacuation. A multiple logistic regression model evaluated whether obstetric-gynecological variables, including pelvic organ prolapse, could discriminate among controls, subjects with fecal incontinence, and subjects with obstructed defecation. Fifty-five percent of controls, 42% of those with obstructed defecation, and 29% of those with fecal incontinence had stage II or greater prolapse by clinical examination. Eleven percent of controls, 7% of those with obstructed defecation, and 47% of subjects with fecal incontinence had a forceps delivery. Eighteen percent of controls, 31% of those with obstructed defecation, and 64% of those with fecal incontinence had a hysterectomy. Even after controlling for a higher prevalence of obstetric risk factors and hysterectomy, fecal incontinence was associated with a lower risk of stage II or greater pelvic organ prolapse (odds ratio for fecal incontinence in > or = stage II pelvic organ prolapse relative to stage 0 pelvic organ prolapse = 0.1, 95% confidence interval 0.01-0.53). In contrast, pelvic organ prolapse severity was not associated with control versus obstructed defecation status. Seven percent of controls, 18% of subjects with obstructed defecation, and 7% of those with fecal incontinence had increased perineal descent during simulated evacuation. Excessive perineal descent was associated (P < .01) with pelvic organ prolapse. Despite a higher prevalence of risk factors for pelvic floor injury, pelvic organ prolapse severity was lower in those with fecal incontinence than in subjects without bowel symptoms. However, a subset of subjects with defecatory disorders, predominantly obstructed defecation, have excessive perineal descent, which is associated with pelvic organ prolapse.

Post-operative magnetic resonance evaluation of children after laparoscopic anorectoplasty for imperforate anus.

Laparoscopic anorectoplasty (LAR) is a relatively new procedure in the treatment of imperforate anus. Using magnetic resonance imaging (MRI), we evaluated the anatomical features of the anorectal region of children treated with LAR and compared this with conventional posterior sagittal anorectoplasty (PSARP). The findings were correlated with functional outcome. A retrospective review of ten children with the high/intermediate types of imperforate anus underwent LAR between May 2000 and December 2002. MRI of the pelvis was performed post-operatively and a semi-quantitative score was used to assess the degree of sphincter symmetry, peri-rectal fibrosis, and the position of the pull-through rectum. The defecation status of these patients was also recorded. Eight historical patients who had undergone PSARP served as a control group. When compared with PSARP patients, a significantly lower proportion of LAR patients had sphincter asymmetry (40 vs. 100%, p < 0.05) and peri-rectal fibrosis (40 vs. 87.5%, p < 0.05). The positioning of the rectum was, however, central for both groups (90 vs. 87.5%). No statistical correlation was found between defecation status and the degree of sphincter asymmetry or peri-rectal fibrosis. LAR allows more optimal anatomical reconstruction for patients with the high/intermediate types of imperforate anus. However, additional factors that are not correctable by surgery, such as intrinsic innervation deficiency, also influence the clinical outcome.

Relationship between lifestyle factors and defecation in a Japanese population.

There is a paucity of accurate data regarding any association in the general population between defecation and lifestyle factors such as diet, exercise, physique, and childbirth. To evaluate the effects of such lifestyle factors on defecation among regional residents of Japan. Residents (n = 1,699) of northern Japan, aged over 40 years, were surveyed in 1995 using a questionnaire to assess their lifestyle factors (diet, beverage consumption, exercise, physique, and childbirth), and examining their defecation status. We evaluated the relationship between these lifestyle factors and defecation using logistic regression analysis. The authors used four measures (defecation frequency, subjective defecation state, subjective fecal properties, and fecal consistency) and assigned the subjects to a group defined by their defecatory status: constipation, diarrhea, or normal, depending on the responses of the subjects to all four criteria. The tendency for constipation correlated positively with age in males ( p = 0.130), although this trend was not observed in females ( p = 0.641). Of the dietary factors examined, only rice, which accounts for the largest proportion of daily dietary fiber intake in Japan, demonstrated a preventive effect on constipation in both sexes ( p = 0.050 in males and 0.003 in females). Walking was a preventive factor for constipation among males ( p = 0.049), and alcohol also inhibited constipation among males ( p = 0.007). These results suggest that exercise, such as walking, and a high intake of dietary fiber, such as rice, were useful in the maintenance of defecation.

Longterm outcomes and quality of life after Z-shaped anastomosis for Hirschsprung’s disease

Background: Z-shaped anastomosis is one of the modifications of Duhamel’s procedure that was designed to eliminate the blind rectal pouch and to achieve complete resection of the colorectal septum. It has been the most widely performed operation in Japan for many years. The longterm postoperative function of evacuation and quality of life of the patients are considered important to evaluate this procedure. Methods: At Kyushu University Hospital, from 1963 to 1997, 127 patients with Hirschsprung’s disease underwent Z-shaped anastomosis. As a result, 122 out of 127 patients (96%) survived. The present status and symptoms, and anorectal functions, including a manometric study and barium enema, were evaluated during the clinical followup. Results: A total of 99 of the 122 surviving patients (81%) were available for this study, and the mean postoperative period was 16 years. Evacuation scores in all patients were as follows; excellent, 62.2%; good, 28.6%; fair, 8.2%; and poor, 1.0%. The percentage of the patients who showed severe symptoms was 4.1% for diarrhea, 3.1% for constipation, 5.1% for incontinence, and 7.1% for soiling. The evacuation score improved chronologically and tended to reach a plateau at 10 to 15 years after operation, at which time 73% of the patients showed excellent outcomes and 95% were satisfactory (good or excellent). The appearance of a sense of defecation and an increase in the pressure difference between the anal canal and the rectum substantially contributed to the improvement in the defecation score. The appearance of the rectosphincteric reflex, including the atypical one, was seen in 40.5% of patients, but the appearance of a reflex did not seem to be related to the clinical status of defecation. Twenty-two of 30 patients older than 20 years were married, and 8 patients had children. Conclusions: The evacuation scores of in-patients undergoing Z-shaped anastomosis improved with age and were satisfactory (good or excellent) in most patients at least 10 years after operation. Most of the patients adapted to a normal social life.

Anorectal function and endopelvic dissection in patients with repaired imperforate anus.

Fifty-eight patients with anorectal malformations were closely followed up for postoperative anorectal function. Constipation was noted shortly after anorectoplasty in 10 of 28 low anomalies (35.7%) treated with limited sagittal anorectoplasty (LSARP), in 18 of 25 high or intermediate anomalies (72.0%) treated with posterior sagittal anorectoplasty (PSARP), but in none of 5 high or intermediate anomalies treated with Rehbein's mucosa-stripping endorectal pull-through and anterior sagittal perineal anorectoplasty (R-ASAP). The constipation resolved mostly within 1-2 years after repair under conservative management, but persisted beyond 2 years after repair in 3/25 children with LSARP and 10/25 with PSARP. Anal soiling was noted in 1/23 (4.3%) LSARP and 6/22 (27.3%) PSARP patients, but normal anorectal function was attained in 20/23 LSARP (86.9%) and 11/12 PSARP patients (50.0%) by the time of toilet training. Manometric studies disclosed that the resting rectal pressure (RRP) was lower and the anorectal pressure gradient (ARPG) higher in the constipated than the non-constipated children, while the RRP was higher and the ARPG lower in the soiled than the non-soiled patients. The ARPG after R-ASPA was close to that of non-constipated and in between that of the constipated and soiled patients. The rectoanal sphincter inhibitory reflex was not related to defecation status or surgical procedures, but showed a tendency toward positive conversion with time or after exclusion of esctatic terminal bowel in the severely constipated. It is concluded that anorectal function in patients with repaired imperforate anus seems to be more affected by the extent of endopelvic dissection than by preservation of the terminal bowel or sphincter muscles.

STUDY OF CONVERSION OF ILEAL TISSUE INTO COLORECTAL TISSUE AND CHANGES IN THE INTESTINAL FLORA IN PATIENTS WITH ILEAL STOMA

To study the formation of colorectal tissue [colonization] of the ileum in cases undergoing total colectomy and ileostomy, a comparative study was performed on the type of stoma formed, defecation conditions including number of evacuations of pouch contents and fecal water content, changes in the intestinal microflora, and formation of colorectal type tissue in the ileal tissue. The results showed that better defecation was maintained when the formation of colorectal tissue was observed. In an examination of the intestinal bacterial flora, both facultative and obligate anaerobes were detected, and the bacterial composition tended to be almost the same as that of the large bowel. The improvement observed in the defecation condition in cases with formation of colorectal tissue suggested that the formation occurred in about 3 months to 2 years postoperatively. The factors which promote the formation of colorectal tissue are still unclear, and it is hoped that this phenomenon will be clarified by future studies.