Celia Keane1, Nira Paskaranandavadivel2, Ryash Vather3, David Rowbotham4, John Arkwright5, Phil Dinning6, Ian Bissett1, Greg O'Grady1. 1. Department of Surgery, University of Auckland, Auckland, New Zealand. 2. Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand. 3. Colorectal Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia. 4. Department of Gastroenterology, Auckland City Hospital, Auckland, New Zealand. 5. College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia. 6. Department of Surgery and Gastroenterology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.
Abstract
AIM: Patients frequently suffer from low anterior resection syndrome (LARS) after distal colorectal resection. The pathophysiology of LARS has not been clearly elucidated. We hypothesized that rectosigmoid resection could impair motility patterns in the distal colon, such as the rectosigmoid brake, which contribute to control of stool form and frequency. METHOD: High-resolution colonic manometry was performed in patients who had previously undergone distal colorectal resection (mean 6.8 years after resection) and non-operative controls before and after a standardized meal. Symptoms were assessed using the LARS score. Propagating contractions were compared between patients with and without LARS, and controls. RESULTS: Data were analysed from 23 patients (11 no-LARS; 12 LARS) and nine controls. All groups demonstrated a significant meal response. LARS patients had fewer post-prandial antegrade propagating contractions than controls (P = 0.028), and fewer retrograde propagating contractions both pre- (P = 0.005) and post-prandially (P = 0.004). Post-prandially, the LARS group had a significantly lower percentage of propagating contractions that met the criteria for the cyclic motor pattern compared to the control group (26% vs. 58%; P = 0.009). There were significant differences in antegrade and retrograde amplitude (P = 0.049; P = 0.018) and distance of propagation (P = 0.003; P = 0.002) post-prandially between LARS patients and controls. CONCLUSION: Rectosigmoid resection alters the meal response following anterior resection, including impairment of the rectosigmoid brake cyclic motor pattern. These findings help to quantify the impaired functional motility after rectosigmoid resection and offer new insights into the mechanisms of LARS.
AIM: Patients frequently suffer from low anterior resection syndrome (LARS) after distal colorectal resection. The pathophysiology of LARS has not been clearly elucidated. We hypothesized that rectosigmoid resection could impair motility patterns in the distal colon, such as the rectosigmoid brake, which contribute to control of stool form and frequency. METHOD: High-resolution colonic manometry was performed in patients who had previously undergone distal colorectal resection (mean 6.8 years after resection) and non-operative controls before and after a standardized meal. Symptoms were assessed using the LARS score. Propagating contractions were compared between patients with and without LARS, and controls. RESULTS: Data were analysed from 23 patients (11 no-LARS; 12 LARS) and nine controls. All groups demonstrated a significant meal response. LARS patients had fewer post-prandial antegrade propagating contractions than controls (P = 0.028), and fewer retrograde propagating contractions both pre- (P = 0.005) and post-prandially (P = 0.004). Post-prandially, the LARS group had a significantly lower percentage of propagating contractions that met the criteria for the cyclic motor pattern compared to the control group (26% vs. 58%; P = 0.009). There were significant differences in antegrade and retrograde amplitude (P = 0.049; P = 0.018) and distance of propagation (P = 0.003; P = 0.002) post-prandially between LARS patients and controls. CONCLUSION: Rectosigmoid resection alters the meal response following anterior resection, including impairment of the rectosigmoid brake cyclic motor pattern. These findings help to quantify the impaired functional motility after rectosigmoid resection and offer new insights into the mechanisms of LARS.
Authors: Cameron E Gaskill; Adam Gyedu; Barclay Stewart; Robert Quansah; Peter Donkor; Charles Mock Journal: World J Surg Date: 2021-06-21 Impact factor: 3.352
Authors: Anthony Y Lin; Chris Varghese; Peng Du; Cameron I Wells; Niranchan Paskaranandavadivel; Armen A Gharibans; Jonathan C Erickson; Ian P Bissett; Greg O'Grady Journal: Biomed Eng Online Date: 2021-10-16 Impact factor: 2.819
Authors: Cameron I Wells; Sameer Bhat; Nira Paskaranandavadivel; Anthony Y Lin; Ryash Vather; Chris Varghese; James A Penfold; David Rowbotham; Phil G Dinning; Ian P Bissett; Greg O'Grady Journal: Physiol Rep Date: 2021-11