Abstract Background Bowel dysfunction after stoma reversal, typically assessed with LARS and Wexner scores, can significantly impair quality of life. This pilot study aimed to evaluate whether pre-closure high-resolution anorectal manometry (ARM) predicts post-closure functional outcomes. Methods In this single-centre retrospective pilot study, 10 consecutive patients undergoing planned stoma reversal were analysed. Demographics, surgical indications, radiotherapy history, surgical details, and time intervals (index surgery–stoma closure; stoma closure–functional assessment) were recorded. Pre-closure ARM included anal resting pressure (RP), squeeze pressure (SP), RAIR, and balloon expulsion test. Post-closure outcomes were assessed using LARS and Wexner scores. Major LARS was defined as =30 and major incontinence as Wexner =11. Results Median age was 59 years (IQR 48–62), 70% were male. Surgical indications included rectal cancer (n = 4), colon cancer (n = 2), Crohn’s disease (n = 4), and Fournier’s gangrene (n = 1). Radiotherapy history was present in 30%. Median stoma duration was 12 months (IQR 8–15.5; mean 16.3), and the interval to functional assessment was 16 months (IQR 6.5–20.3; mean 16.1). Median RP was 31 mmHg and SP 77 mmHg. Balloon expulsion failed in 40%, and RAIR was absent in 30%. After reversal, 20% developed major LARS and 40% major incontinence. RP (AUC 0.69) and SP (AUC 0.72) moderately discriminated major LARS, whereas discrimination for major Wexner was limited (RP 0.54; SP 0.60). BMI showed strong positive correlations with LARS (r = 0.919, p = 0.003) and Wexner (r = 0.775, p = 0.041). Time intervals were not significantly correlated with outcomes (all p 0.05). RAIR absence coincided with higher major incontinence (66.7% 2/3 vs 28.6% 2/7; OR = 5.0). Conclusion In this pilot series, pre-closure ARM, particularly low resting pressure, may help predict severe LARS after stoma reversal. Although predictive value for incontinence was limited, higher BMI was strongly associated with worse functional outcomes, and RAIR absence tended to indicate increased risk, though not statistically significant. Conflict of interest: Dağcı, Gizem: No conflict of interest Bilgin, Ersel: No conflict of interest Mammadov, Sabuhi: No conflict of interest Agargun, Besim Fazil: No conflict of interest Telli, Pelin: No conflict of interest Gurbanov, Asim: No conflict of interest Yağlı, Mehmet Akif: no conflicts of interest Genc Ulucecen, Sezen: No conflict of interest Cavus, Bilger: No conflict of interest Akyüz, Filiz: No conflict of interest
Dağcı et al. (Thu,) studied this question.