Sigmoidectomy syndrome? Patients' perspectives on the functional outcomes following surgery for diverticulitis.

To the Editor—The study of Levack et al showed that a sigmoid colectomy for diverticulitis is frequently related to postoperative suboptimal bowel function (fecal incontinence, urgency, and incomplete emptying). Despite the authors' correctly described relationship between the 2 events, they could not identify how bowel function might be influenced by surgery. We believe that the study that we recently published focusing the influence of preserving the inferior mesenteric artery (IMA) during left hemicolectomy on defecatory function might be a possible answer to the open questions left by Dr Levack’s study. In patients undergoing left hemicolectomy, especially anterior rectal resection, the presence of postoperative defecatory disorders characterized by fecal incontinence, soiling, urgency, alternate bowel function, and stool fragmentation was previously described. After sigmoidectomy for diverticular disease, the defecatory disorders that may follow are mainly related to the section of the IMA at its origin, or just below the origin of the left colic artery, which leads to the lesion of the ascending nervous fibers coming from the pelvic plexus as well as the descending fibers coming from the inferior mesenteric plexus and that run around this vessel. Our study demonstrated that the preservation of the IMA, dividing the sigmoid artery near to the colonic wall, allows the colonic denervation to be reduced. This improves intestinal function with a statistically lower incidence of disorders of defecation, such as fragmented evacuations, alternating bowel function, constipation, and minor incontinence, with less lifestyle alteration. The preservation of the IMA should be recommended in sigmoidectomy or left hemicolectomy for diverticular disease to avoid postoperative defecatory disorders.