Abstract
Under standardized conditions, the manometric motility of the distal colon following rectosigmoid anastomosis (N=11, median age 70 years, range 47–80), was compared to that following laparotomies not involving colonic anastomosis (N=9, 56 years, 32–65). Microtransducer probes were inserted peroperatively and colonic activity recorded continuously (median 96 hr, range 48–109 anastomotic and 75 hr, range 46–107 control group) employing an ambulatory system. Quantitative indices of motility were calculated with an automated analysis program. Total postoperative analgesic doses and duration of surgery were similar in both groups. The first return in the anastomotic group of isolated waveforms [median 1.8 hr, interquartile range (IQR) 1–3] and propagated waves (92 hr, 79–100), was comparable to the control group (4 hr, 1.8–7, and 73 hr, 72–101, respectively). Motor complexes, characterized by bursts of regular contractile activity at 3–5 cpm, returned faster in the control group (3 hr, 2–24 vs 24 hr, 19–30,P<0.05). Motility index was significantly depressed during the first 72 hr following surgery in the anastomotic group compared to controls (P<0.001). Flatus was passed at a median of 72 hr (IQR 45–79) in the control and 94 hr (81–105) in the anastomotic group (P=0.05). The presence of a left-sided colonic anastomosis has a major inhibitory effect on distal colonic motility, compared to nonanastomotic surgery of similar severity, in the early postoperative period.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Graber JN, Schulte WJ, Condon RE, Cowles VE: Relationship of duration of postoperative ileus to extent and site of operative dissection. Surgery 92:87–92, 1982
Neely J, Catchpole B: Ileus: The restoration of alimentary-tract motility by pharmacological means. Br J Surg 58:21–28, 1971
Nachlas MM, Younis MT, Roda CP, Wityk JJ: Gastrointestinal motility studies as a guide to postoperative management. Ann Surg 175:510–522, 1972
Woods JH, Erickson LW, Condon RE, Schulte WJ, Sillin LF: Postoperative ileus: A colonic problem? Surgery 84:527–533, 1978
Rothnie NG, Harper RA, Catchpole BN: Early postoperative gastrointestinal activity. Lancet 2:64–67, 1963
Wilson JP: Postoperative motility of the large intestine in man. Gut 16:689–692, 1975
Condon E, Vowles VE, Schulte WJ, Frantzides CT, Mahoney JL, Sarna SK: Resolution of postoperative ileus in humans. Ann Surg 203:574–581, 1986
Rogers J, Henry MM, Misiewicz JJ: Increased segmental activity and intraluminal pressures in the sigmoid colon of patients with the irritable bowel syndrome. Gut 30:634–641, 1989
Waldhausen JHT, Shaffrey ME, Skenderis BS, Jones RS, Schirmer BD: Gastrointestinal myoelectric and clinical patterns of recovery after laparotomy. Ann Surg 211:777–785, 1990
Burkitt DS, Donovan IA: Intraluminal pressure adjacent to left colonic anastomoses. Br J Surg 77:1288–1290, 1990
Tinkler LF: Surgery and intestinal motility. Br J Surg 52:140–150, 1965
Aitkenhead AR: Anaesthesia and the gastro-intestinal system. Eur J Anaesth 5:73–112, 1988
Condon RE, Cowles V, Dkbom GA, Schulte WJ, Hess G: Effects of halothane, enflurane and nitrous oxide on colon motility. Surgery 101:81–85, 1987
Wattwil M: Postoperative pain relief and gastrointestinal motility. Acta Chir Scand Suppl 550:140–145, 1988
Neely J: The effects of analgesic drugs on gastro-intestinal motility in man. Br J Surg 56:925–929, 1969
Morris DL, Clark AG, Evans DF, Hardcastle JD: Study of postoperative gastrointestinal motility in man using radiotelemetry. Gut 26:A1142, 1985
Bassotti G, Bucaneve G, Pelli MA, Morelli A: Contractile frequency patterns of the human colon. J Gastrointest Motil 2:73–78, 1990
Kumar D, Williams NS, Waldron D, Wingate DL: Prolonged manometric recording of anorectal motor activity in ambulant human subjects: evidence of periodic activity. Gut 30:1007–1011, 1989
Painter NS, Truelove SC: The intraluminal pressure patterns in diverticulosis of the colon. Part IV The effect of pethidine and probanthine. Gut 5:369–373, 1964
Kumar D, Soffer EE, Wingate DL, Britto J, Das-Gupta A, Mridha K: Modulation of the duration of human postprandial motor activity by sleep. Am J Physiol 256:G851-G855, 1989
Narducci F, Bassotti G, Gaburri M, Morelli A: Twenty four hour manometric recording of colonic motor activity in healthy man. Gut 28:17–25, 1987
Holdstock DJ, Misiewicz JJ, Smith T, Rowlands EN: Propulsion (mass movements) in the human colon and its relationship to meals and somatic activity. Gut 11:91–99, 1970
Flourie B, Phillips S, Richter H, Azpiroz F: Cyclic motility in canine colon: Responses to feeding and perfusion. Dig Dis Sci 34:1185–1192, 1989
Kerlin P, Zinsmeister A, Phillips S: Motor responses to food of the ileum, proximal colon, and distal colon of healthy humans. Gastroenterology 84:762–770, 1983
Snape WJ, Mastarazzo SA, Cohen S: Effect of eating and gastrointestinal hormones on human colonic myoelectrical and motor activity. Gastroenterology 75:373–378, 1978
Snape WJ, Wright SH, Battle WH, Cohen S: The gastrocolic response: Evidence for a neural mechanism. Gastroenterology 77:1235–1240, 1979
Wright SH, Snape WJ, Battle W, Cohen S, London RL: Effect of dietary components on gastrocolonic response. Am J Physiol 238:G228-G232, 1980
Misiewicz JJ: Colonic motility. Gut 18:311–314, 1975
Author information
Authors and Affiliations
Additional information
Funded by M.R.C. grant.
Rights and permissions
About this article
Cite this article
Roberts, J.P., Benson, M.J., Rogers, J. et al. Characterization of distal colonic motility in early postoperative period and effect of colonic anastomosis. Digest Dis Sci 39, 1961–1967 (1994). https://doi.org/10.1007/BF02088132
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02088132