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Postoperative defecatory malfunction inherent in the intersphincteric resection (ISR) for low rectal cancer
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K. Koda1,
C. Kosugi1,
K. Shuto1 |
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1Teikyo University Chiba Medical Center |
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| In the process of ISR, internal sphincter muscle is, at least in part, removed during the maneuver. As has been discussed, internal sphincter muscle is composed of two parts; one is a circular muscle and another is a longitudinal part which is a partial extension of rectal longitudinal smooth muscle. The remaining part of the rectal longitudinal muscle is believed to spread circumferentially at the bottom of the pelvis to form hiatal ligament. It has been explained that the hiatal ligament works as the connecting part between the rectal wall and the levator ani muscles, then help to open the anal canal at defecation. Especially, the posterior part of the hiatal ligament is thickened and have been regarded as rectococcygeus muscle.The muscle has an important role for shortening the rectal wall at defecation and for helping the feces evacuated. These normal defecatory processes may be impaired through the operative maneuver of ISR. The manometry test indicated that the length of the functional anal canal become short with the resting anal pressure decreased in patients that underwent ISR. When examined with the X-ray defecography, majority of the cases are not able to hold liquid feces unless they squeeze intentionally. The defecatory function seen in patients that underwent ISR and possible approach for relieving symptoms are discussed. |
Index Term 1: intersphincteric resection
Index Term 2: defecatory function |
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