Abstracts
2000 Digestive Disease Week

# 2235 The Influence of Faecal Diversion (Hartman Procedure) on Anorectal Motility and Perception.
Roman M. Herman, Piotr Walega, Tadeusz Popiela, Krakow, Poland

Faecal diversion (Hartman’s operation) is still commonly used as the firststage emergency procedure in complicated diverticular disease.Most of these patients required further restoration of colon continuity (colostomy closure). However anorectal function following restoring intestinal continuity is frequently disturbed,especially when Hartman’s reversion is delayed.In order to establish the main predictive factors influencing postoperative anorectal dysfunction,anal sphincters manometry and rectal barostat study were performed in 12 patients(8male and 4 female)with complicated diverticular disease(pericolic abscess or acute phlegmon). Methods: Anorectal vectorvolume manometry,and rectal barostat study were performed in each patient before and after Hartman’s procedure, as well as following restorative surgery(Hartman’s reversion) using Synectics Motility System and Synectics SVS Barostat. Continence control was assessed using saline enema test and Wexner Incontinence Scoring System(ISS). Control group included 12 healthy volunteers without anorectal dysfunction. The study was approved by the university scientific and ethical committee. Results: Anorectal motility was significantly disturbed when studied 1 month following faecal diversion. Resting and squeeze anal pressure decreased as compared to preopertive and control values, rectal compliance was reduced, and rectal perception increased. All the patiens were unable to retain salin enema(150 ml). One month after restoration of intestinal continuity 10 of 12 patients reported significant anorectal dysfunction: increased frequency of erratic defecatory patterns, tenesmus,urgency,flatusfaecal incontinence or obstructed defecation. Resting anal pressure was still lower and vector volume reduced as related to preop. Value. During barostat study rectal compliance gradually increased,while rectal perception patterns(maximal tolerable volume, sensitivity index) only slightly increased as compared to postop. Results. Vector volume and maximal tolerable volume (MTV) predict early postoperative anorectal dysfunction after Hartman’s reversion. Conclusion: Faecal diversion significantly influences anorectal motility and perception. Complete diagnostic workup including anorectal volume manometry and rectal barostat study can select the patients with expected anorectal dysfunctions before restoration of intestinal continuity.