Benign functional anorectal conditions: a multi-centre analysis of rectal stump symptomatology in patients undergoing stoma formation

TL;DR

This study examines rectal symptoms in patients who had a stoma for benign anorectal issues, finding that many experience ongoing symptoms requiring management.

Contribution

The study provides the first multi-centre analysis of rectal stump symptomatology after stoma formation for benign functional anorectal conditions.

Findings

51% of patients experienced problematic rectal mucus discharge after stoma formation.

65% of patients required interventions like enemas or proctectomy to manage symptoms.

92% of patients achieved satisfactory symptom control with a median follow-up of 3 years.

Abstract

Functional anorectal conditions are common, and management is challenging. Conservative management may not always be successful and some of these patients may opt for stoma formation. Rectal stump symptomatology after surgery is poorly understood with limited existing literature in this field. The aim of this study is to investigate the prevalence of rectal stump symptomatology in patients undergoing stoma creation for benign functional anorectal conditions.

A retrospective chart review for patients undergoing stoma formation for functional anorectal conditions at two metropolitan hospitals was conducted. Patient demographics and incidence of rectal stump symptoms were documented and analysed.

Thirty-nine patients underwent stoma formation over a 7-year period. The average age was 55 years and 90% of patients were female. End colostomy was performed in 23 (59%) patients, one patient underwent a loop colostomy, and the remaining patients (15) underwent loop ileostomy. Post-operative symptoms associated with the rectal stump were common and included problematic rectal mucus discharge (51%), pelvic pain (21%), rectal impaction (5%), tenesmus (3%) and rectal prolapse (3%). Overall, 65% of patients underwent at least one intervention for persistent rectal mucus discharge, including enemas (38%), irrigation (38%) or completion proctectomy (23%). In total, 92% of patients were noted to have satisfactory control of symptoms with a median follow-up time of 3 years.

Rectal stump symptomatology is common in patients undergoing a defunctioning stoma for benign functional anorectal conditions. Many of these patients require ongoing management to control their symptoms, including in some cases a completion proctectomy. This study forms the basis for further research on rectal stump symptomatology in this complex cohort of patients.

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