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Does a defunctioning stoma affect anorectal function after low rectal resection?: Results of a randomized multicenter trial
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
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2011 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 54, no 6, 747-752 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Anorectal function is often impaired after low anterior resection of the rectum. Many factors affect the functional outcome and not all are known.

OBJECTIVE: This trial aimed to assess whether a temporary defunctioning stoma affected anorectal function after the patients had been stoma-free for a year.

DESIGN: Multicenter randomized controlled trial.

SETTING: Twenty-one Swedish hospitals performing surgery for rectal cancer participated.

PATIENTS: Patients who had undergone low anterior resection for adenocarcinoma of the rectum were eligible.

INTERVENTIONS: Patients were randomly assigned to receive a defunctioning stoma or no stoma.

MAIN OUTCOME MEASURES: Anorectal function was evaluated with a questionnaire after patients had been without a stoma for 12 months. Questions pertained to stool frequency, urgency, fragmentation of bowel movements, evacuation difficulties, incontinence, lifestyle alterations, and whether patients would prefer a permanent stoma.

RESULTS: After exclusion of patients in whom stomas became permanent, a total of 181 (90%) of 201 patients answered the questionnaire (90 in the stoma group and 91 in the no-stoma group). The median number of stools was 3 during the day and 0 at night in both groups. Inability to defer defecation for 15 minutes was reported in 35% of patients in the stoma group and 25% in the no stoma group (P = .15). Median scores were the same in each group regarding need for medication, evacuation difficulties, fragmentation of bowel movements, incontinence, and effects on well-being. Two patients (2.2%) in the stoma group and 3 patients (3.3%) in the no-stoma group would have preferred a permanent stoma.

LIMITATIONS: Because this study was an analysis of secondary end points of a randomized trial, no prestudy power calculation was performed.

CONCLUSIONS: A defunctioning stoma after low anterior resection did not affect anorectal function evaluated after 1 year. Many patients experienced impaired anorectal function, but nearly all preferred having impaired anorectal function to a permanent stoma.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2011. Vol. 54, no 6, 747-752 p.
Keyword [en]
Rectal cancer, Anorectal function, Defunctioning stoma
National Category
URN: urn:nbn:se:umu:diva-57212DOI: 10.1007/DCR.0b013e3182138e79PubMedID: 21552061OAI: diva2:540514
Available from: 2012-07-10 Created: 2012-07-10 Last updated: 2012-08-21Bibliographically approved

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