Functional results for ultra-low resections of the rectum

Abstracts Introduction The understanding of the mechanisms concerning fecal continence has undergone a considerable impulse due to the need to reduce demolition interventions with the possibility of a definitive colostomy. (1,2,3,4) The rectus responsible for the accumulation of faecal material up to moment of defecation does not need a rectal peristaltic activity. the aim of the present study is to evaluate and analyze the functional modifications of ano rectal continence after restoration of intestinal continuity by packaging an anastomosis on the rectal abutment, or in anal colo or on the combed line. Materials and methods : From January 2010 to December 2017 consulted the database of the AOU polyclinic University of Catania were observed in 25 cases of neoplasia in the rectum and in 6 cases of colon neoplasia with seat: sigma (6.2%)) studied at the Department of Medical Surgical Sciences and specialist II Patients selected for this analysis had a mean age of 72 years (range 74-70). All patients performed digital exploration of the rectum. The colonscopy (fig 1,) the diagnostic imaging (CT and MRI) with which it obtained the staging of the neoplasms if. the TNM, subsequently the therapeutic path was completed by implementing the manometry. Results: The removal of cancer of the rectum is associated with the removal of the midle rectum and its pedicle until the origin of the inferior mesenteric artery exposes to the risk of nerve lesions with consequences on the sensibility of the residual rectum, on the sphincter function but also on the function bladder. The instrumental examinations were conducted after 6- 15-36 months from the surgical treatment. In the group of patients undergoing a curative intervention that included rectal colic anterior resections with mechanical or manual anastomosis in 16 cases (64%) and in colon anal interventions in 4 cases (13%), I noticed a variable reduction in basal sphincter tone , of the new rectum compliance only in the first 6 months post-intervention. Discussion: Anterior resection of the rectum involves a variety of specific symptoms such as increased frequency of evacuations, a different mode of defecation, urgency, difficulty with evacuation and continence disorders. The main causes are the decrease in the capacity and the compliance of the rectum, an alteration of the tone of the internal anal sphincter and the loss of the injured anal rectal reflex. The factors that influenced the lifestyle were: the excessive frequency, fragmentation and the incontinence. The incidence of functional disorders reached 90% in the first 6 months of the postoperative period to improve within 1-2 years. Conclusion: The saving of sympathetic and parasympathetic nervous structures represents the measure for the best conservation of the urinary and faecal containment and expulsive function. Attention to at least partial preservation of the internal sphincter and total removal of the rectum associated with current reconstruction techniques contribute to the reduction of the evacuation disorders of the sphincter function before and after the operation.