Defecation Dysfunction After Laparoscopic Intersphincteric Resection

Research background and purpose:In recent years,intersphincteric resection（ISR）has been recognized by both doctors and patients as an ultra-low anus-preserving surgery.As laparoscopic ISR surgery continues to challenge the new limit of sphincter preservation,the preservation of defecation function has also become a new requirement for more and more patients.After radical resection of low rectal cancer,"Low anterior resection syndrome（LARS）",which is characterized by increased defecation frequency,incontinence,urgency,and emptying disturbance as the main symptoms,greatly affects the overall efficacy of ISR surgery.and prognosis quality of life.Therefore,fully understanding the impact of laparoscopic ISR surgery on anal function,and analyzing the risk factors of LARS,are mainly in the comprehensive treatment of LARS,and improve the prognosis.Methods:A total of 79 patients undergoing laparoscopic ISR surgery from January 2018 to January 2020 in the Department of Gastroenterology and Colorectal Surgery of the First Hospital of Jilin University were selected as the research subjects.The clinical data of the patients were retrospectively analyzed and a 24-month postoperative follow-up was conducted to evaluate the defecation function at different stages after the operation,and to analyze the independent risk factors of LARS after laparoscopic ISR.SPSS 26.0 software was used for statistical analysis of the obtained data.The enumeration data were expressed as the number of cases,and the chi-square test was used.The rank data were tested by the rank sum test.Spearman was used to analyze the correlation between the severity of LARS and different time after operation.Risk factors were analyzed using logistic regression.P<0.05 was regarded as a statistically significant difference.Results:Among the 79 patients after laparoscopic ISR,31（39%）had no LARS,48（61%）had LARS,and 30（38%）had severe LARS.After 24 months of postoperative follow-up,44 patients（54%）had no LARS,23（29%）had mild LARS,and 12（17%）had severe LARS.Cramer V coefficient analysis showed that with the increase of time,the disease severity of the population gradually decreased,and time was negatively correlated with the degree of LARS（Cramer V=0.145,P=0.038）.Univariate analysis showed that there were significant differences in age,the distance between the anastomosis and the anal verge,and the diameter of the specimen between the two groups（P<0.05）.Multivariate logistic regression analysis showed that age,the distance from the anastomosis to the anal verge,and the diameter of the specimen were the related factors affecting the occurrence of LARS（P<0.05）.Conclusion:1.Most patients after laparoscopic ISR will develop LARS of different degrees,and the incidence of severe LARS is high.2.Over time,the severity of LARS gradually decreased within 2years after surgery,and some severe LARS clinical symptoms could not be relieved.3.Distance from anastomosis to anal verge,tumor diameter and age are independent risk factors for LARS after laparoscopic ISR.