Defecatory malfunction caused by motility disorder of the neorectum after anterior resection for rectal cancer

BACKGROUND: The correlation between postoperative defecatory status after anterior resection for rectal cancer and physiologic neorectal motility has not been well delineated. METHODS: Sixty patients who underwent anterior resection were examined. Motility of the neorectum was examined with 4-sensor intraluminal pressure monitoring, and segmental colonic transit time was determined with radiopaque Sitzmarks (Konsyl, Fort Worth, Texas) capsules. RESULTS: Twenty-eight patients experienced loss of propagated contraction waves down to the neorectum, which was closely correlated with a prolonged transit time through the neosigmoid colon and neorectum. In 26 patients, minor spastic waves were observed at the neorectum, which did not correlate well with the loss of propagated waves. The loss of propagation and the existence of spastic waves were significantly correlated with urgency of defecation and multiple evacuations. The latter was also associated with major soiling and with patients' assessments of impaired defecatory function. CONCLUSIONS: The physiologic motility of the neorectum is one of the factors responsible for postoperative defecatory function after anterior resection for rectal cancer.