Enteric physiology, neuropathology, and bowel function following colorectal resections in adults and children

Optimal functional outcomes following colorectal resections are important to people suffering from colorectal cancer or born with a colorectal disorder. In this thesis, we assessed long-term functional outcomes following colorectal surgery in adults and children, combined with studies of the physiological function and neural innervation of the bowel.

In Part I, we presented fundamental studies regarding anorectal physiology, showing a newly investigated pathway between the anal canal and the rectum (the anorectal defecation reflex), which appears to play a role in defecation.

In Part II, we discussed the presence of bowel function problems in the adults and children of the general population. We showed how bowel function could be measured from infancy till childhood using the newly developed Early Pediatric Defecation and Fecal Continence questionnaire.

In Part III, we investigated the long-term functional outcomes following oncological colorectal resections in adults. We concluded that even though bowel function problems continue to exist years after surgery for colorectal cancer, most patients remain untreated.

In Part IV, we evaluated the long-term functional outcomes following colorectal resections because of Hirschsprung’s disease in children. Surprisingly, in the long term, patients with Hirschsprung’s disease with a long aganglionic segment do not suffer from more fecal incontinence compared to patients with aganglionosis limited to the rectosigmoid.

In Part V, we concluded that the remaining ganglionic colon of patients with Hirschsprung’s disease contains many neural deficiencies. For example, the colon shows a relative overabundance of nitrergic neurons and larger neurons, which correlates with severe postoperative constipation.