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The Role of Preoperative Evaluation of Coloanal Motor Function

Michael E. Zenilman, MD; Deanna L. Dunnegan, RN; Nathaniel J. Soper, MD; James M. Becker, MD

Arch Surg. 1989;124(8):947-951.

Abstract
• Identification of patients with severe idiopathic colonic dysmotility who would benefit from surgery can be difficult. Colonic transit studies and anorectal manometry were applied to 12 women with severe constipation before subtotal colectomy. Delayed transit was noted in all patients with most exhibiting left-sided colonic arrest. Mean anal resting pressure and rectal capacity were similar to that in healthy controls. Pathologic examination results revealed decreased argyrophilic neurons in the colonic myenteric plexus. At 24 months postoperatively, all patients were satisfied with their results and mean ( ± SEM) weekly bowel movement frequency was 17 ± 3 (compared with 0.8 ± 0.2 preoperatively). Preoperative coloanal function studies therefore aid in the selection of patients who will be successfully treated by surgery. Subtotal colectomy with ileorectal anastomosis is the preferred operation because dysmotility can originate from either side of the colon.

(Arch Surg. 1989;124:947-951)

Author Affiliations
From the Department of Surgery, Washington University School of Medicine, St Louis, Mo.

Footnotes
Accepted for publication March 27, 1989.

Read before the 96th Annual Meeting of the Western Surgical Association, San Diego, Calif, November 16, 1988.

Reprint requests to Washington University School of Medicine, One Barnes Hospital Plaza, Suite 6108, St Louis, MO 63110 (Dr Becker).

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