Does a Defunctioning Stoma Affect Anorectal Function After Low Rectal Resection? Results of a Randomized Multicenter Trial

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.