Stool dynamics after extrinsic nerve injury during right colectomy with extended D3-mesenterectomy

Figures & data

Figure 1. The D3-dissection. The figure depicts the radicality of the central dissection. (A) After opening the left side of the mesentery along a line following the medial border of the superior mesenteric artery (SMA), the surgeon opens the artery's vascular sheath. Dissecting toward the right in the well-defined plane between the vessels and their sheaths, the surgeon lifts the anterior flap. Here we see that the ileocolic artery (ICA) crosses the superior mesenteric vein in the front. (B) Now, the ICA and the ileocolic vein are ligated and divided at their origins. SMV is carefully pulled to the left as the posterior flap is dissected out from behind the SMA, still in the plane between the artery and the vascular sheath. The dorsal delimitation of this flap is Toldt’s fascia. (C) Pictures the specimen with the vascular groove and the inner surface of the two flaps. (D) Depicts the mesentery, the two flaps, and the vascular groove from another angle.

Figure 2. (A) The graphs depict the stool trends during the first 60 d after right colectomy with a traditional D2-mesenterectomy using a 3-points moving average. The graphs represent the total number of stools per day, as well as the number of formed, loose and watery stools per day. (B) The graphs depict the stool trends during the first 60 d after right colectomy with extended D3-mesenterectomy using a 3-points moving average. The graphs represent the total number of stools per day, as well as the number of formed, loose, and watery stools per day.

Table 1. Postoperative scores (after recovery) in the groups (D2/D3), differences between the groups without and with control for preoperative scores

Mean postoperative scores	D2	D3	Δ	Difference D2/D3 (linear regression)
				Regr. Coeff.^a	CI	p Value
DAS Total score (0–12)	2.25	2.97	0.72	0.845	−0.42 to 2.11	.19
-Frequency score (0–3)	0.42	0.71	0.29	0.120	−0.30 to 0.54	.57
-Consistency (0–3)	0.42	0.87	0.45	0.484	0.02–0.94	.039
-Urgency (0–3)	0.83	0.97	0.13	0.105	−0.48 to 0.69	.72
-Discomfort (0–3)	0.58	0.44	−0.15	0.022	−0.37 to 0.41	.91
GIQLI total score (0–144)	111.1	111.2	0.1	−4.410	−14.71 to 5.89	.39
-Physical role (0–44)	34.6	34.6	0.07	−0.572	−5.18 to 4.04	.80
-Colon function (0–32)	19.5	17.3	−2.22	−2.766	−6.15 to 0.62	.11
-Emotional role (0–32)	24.2	24.2	−0.06	−0.506	−4.15 to 3.14	.78
-Upper GI function (0–32)	25.5	26.8	1.26	0.378	−2.10 to 2.86	.76
-Meteorism (0–12)	8.3	7.9	−0.46	−1.228	−2.46 to 0.01	.052
SF36 – Physical functioning (0–100)	68.6	85.9	17.1	3.205	−7.69 to 14.10	.55
SF36 – Role-physical (0–100)	56.3	71.1	14.8	6.876	−20.56 to 34.31	.61
SF36 – Bodily pain (0–100)	76.1	82.1	6.0	−3.598	−18.11 to 10.91	.62
SF36 – General health (0–100)	65.3	76.4	11.1	4.338	−9.61 to 18.29	.53
SF36 – Vitality (0–100)	65.3	61.2	−4.0	−5.622	−17.94 to 6.70	.36
SF36 – Social functioning (0–100)	77.1	86.3	9.2	−1.299	−17.31 to 14.71	.87
SF36 – Role-emotional (0–100)	69.6	86.5	16.9	13.086	−11.17 to 37.34	.28
SF36 – Mental health (0–100)	82.5	83.0	0.5	1.076	−10.95 to 13.10	.86
Degree of disturbance (0–3)	0.42	0.75	0.33	0.427	−0.13 to 0.99	.13

ΔThe difference between the D2 and D3-group. ^aRegression coefficients controlled for preoperative data (The effect of being in the D3-group).

CI: confidence interval; GIQLI: Gastrointestinal Quality of Life Index; DAS: Diarrhea Assessment Scale (A tool for estimating diarrhea on a scale of 0–12, where 0 is best, and 12 represents severe diarrhea) Individual DAS questions and scoring: Frequency of stools per day: 0: 0–1 stools per day 1: 2 stools per day 2: 3 stools per day 3: 4 or more stools per day; Consistency of stools per day: 0: all stools formed 1: stools formed and loose 2: stools loose 3: watery stools; Urgency of stools: 0: no urgency 1: somewhat urgent 2: urgent 3: very urgent; Abdominal discomfort: 0: no discomfort 1: mild-moderate 2: somewhat severe 3: very severe discomfort.), SF36: Short-form 36 Health Status Questionnaire