Background: The aim of this study was to evaluate the subjective anorectal function in patients with
left hemicolectomy and to clarify the clinical factors influencing postoperative anorectal function
problems.
Materials and Methods: One hundred and twenty one patients who underwent left hemicolectomy
from April 2002 to December 2003 were enrolled in this study and sent questionnaires concerning
anorectal function. Left hemicolectomy in patients with cancer was performed by high ligation of
the inferior mesenteric artery; in patients with diverticulitis or polyposis, the inferior mesenteric
artery was cut just below the branch of the left colonic artery. One hundred patients replied to the
questionnaire: 52 men and 48 women, aged 37 to 85, with a mean age of 66.6 years. Differences
were analyzed for statistical significance by the Chi square test and by logistic regression.
Results: Anorectal function problems was present in 33% of patients: female gender (P = 0.02),
laparoscopic surgery (P = 0.04), and postoperative diarrhea (P = 0.04) had significant independent
effects on anorectal function problems. Transient early fecal incontinence was observed in 16% of
patients and laparoscopic surgery had significant independent effects on this problem (P = 0.04).
Inability to discriminate between gas and stool, tenesmus, or urgency were present in 21%, 18%,
and 17% of cases, respectively, and were independently associated respectively with laparoscopic
surgery (P = 0.005) and postoperative diarrhea (P = 0.019) (P = 0.015).
Conclusion: In our study the following two issues were clarified: anorectal function problems are
frequent after left hemicolectomy, and the laparoscopic technique is linked to poor postoperative
anorectal function. The technical methods of high ligation of the inferior mesenteric artery could
explain this result.
