The relationship between the time from intestinal diversion to restoration and the associated manometric changes is a relevant issue in clinical practice. Current literature suggests that the duration of fecal diversion may impact bowel function and postoperative outcomes.
Anorectal manometry plays a key role in minimizing the risk of incontinence and guiding appropriate treatment decisions. However, there is a lack of consistent data regarding its usefulness in patients undergoing colostomies and subsequent stoma closure.
Objective: To evaluate the relationship between the time interval until restoration of intestinal transit and anorectal function assessed by high-resolution anorectal manometry.

A retrospective cross-sectional study was performed, including patients who underwent anorectal manometry prior to intestinal transit restoration. The values reported were associated with the time in months since bowel diversion. Statistical analysis was performed using Spearman's rho, Student's t-test and chi-square as required. Data were obtained with IBM SPSS Statistics version 30.0.

A total of 10 patients were included in the study. The mean age was 49.0 years (SD ± 12.0), ranging from 33 to 65 years. Regarding sex distribution, 60% were female (n=6) and 40% were male (n=4).

The mean time from intestinal diversion to bowel continuity restoration was 17.3 months (SD ± 8.86), with a minimum of 11 months and a maximum of 39 months.
Regarding anorectal manometric findings: Defecatory dyssynergia was identified in 3 patients, hypotonia of the anal sphincter was observed in 5 patients, hypocontractility was found in 2 patients and rectal hypersensitivity was present in 5 patients.

In 30% of patients, high-resolution anorectal manometry was performed more than 20 months after intestinal diversion, and in the rest less than 20 months.

As shown in Table 1 statistically significant difference was observed in the High-Pressure Zone (HPZ), which was lower in the delayed restoration group (p = 0.033), suggesting a potential impact of prolonged fecal diversion on anal sphincter tone. No other parameters reached statistical significance, although trends toward altered rectal pressures and sensory thresholds were noted.

Figure 1 illustrates the difference in High Pressure Zone (HPZ) values, measured by anorectal manometry, between patients who underwent bowel continuity restoration within 20 months and those with delayed restoration (>20 months). Patients with a delay greater than 20 months showed significantly lower HPZ values, suggesting an association between prolonged fecal diversion and impaired anorectal function.

Figure 2 compares the time interval (in months) between intestinal diversion and restoration in patients with and without anorectal hypocontractility. Patients with hypocontractility had significantly longer diversion periods, indicating that prolonged fecal diversion may contribute to impaired rectal contractility detected on manometric evaluation.

Parra-Izquierdo et al (2023) conducted a descriptive study to evaluate this comparison, reporting 68% of patients with hypotonia and 30% with defecatory dyssynergia, concluding by questioning the cost-effectiveness, since most hypotonic patients presented adequate continence after restoration. 

There are no other studies that evaluate manometric alterations with time of evolution. Studies with a larger population and with a better statistical design are needed.

In summary, the time from bowel diversion to restoration may influence manometric outcomes, however, prediction of postoperative functional outcomes may require a more comprehensive assessment that considers multiple factors, not just detour time.

Parra-Izquierdo V, Flórez-Sarmiento C, Arias P, Kock J,Márquez JR, Frías-Ordóñez JS, Ardila-Báez MA. Utilidadde la manometría anorrectal prequirúrgica para el cierre de ostomías: un estudio de corte transversal. Revista.colomb. Gastroenterol. 2024;39(1):44-50.
ee TH, Bharucha AE. How to Perform and Interpret High-resolution Anorectal Manometry Test. J Neurogastroenterol Motil. 2016;22(1):46-59
Schwandner F, Klimars U, Gock M, et al. The Water-Holding Procedure for Ensuring Postoperative Continence Prior Restoring Intestinal Continuity. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract. 2020;24(2):411-417.