• Branko Bakula, Žarko Rašić, Dragan Jurčić, Marko Lucijanić, and Fran Rašić.
• 1Department of Abdominal Surgery, Sveti Duh University Hospital, Zagreb, Croatia; 2Department of Gastroenterology, Sveti Duh University Hospital, Zagreb, Croatia; 3Department of Hematology, Dubrava University Hospital, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
• Acta Clin Croat. 2020 Dec 1; 59 (4): 703-711.

AbstractAnterior rectal resection is a standard surgical procedure for treating carcinomas of rectum and distal sigmoid colon. In many cases of anterior rectal resection, postoperatively some level of fecal incontinence may occur. The aim of our study was to evaluate the impact of the colorectal anastomosis level on anorectal functional disorder. In our prospective study, the participants were patients diagnosed with carcinoma of rectum or distal sigmoid colon. All patients underwent standard open or laparoscopic anterior rectal resection. Six months after the surgery, the function of anorectum was evaluated in all participants. Finally, 38 patients were analyzed, including 13/38 (34.2%) patients with high rectal anastomosis, 11/38 (28.9%) with mid rectal anastomosis and 14/38 (36.8%) with low rectal anastomosis. Patients with a lower level of anastomosis had a statistically significantly greater number of stools, higher urgency and discrimination impairment, more pronounced solid, liquid and gas incontinence, and greater need for diapers (p<0.05 all). Therefore, patients with lower anastomosis had a statistically significant impairment of their quality of life and higher Wexner score (p<0.001 for both analyses). Our study results suggested reduced neorectal capacity to be the main pathophysiological factor for the development of postoperative anorectal function impairment.

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