Bowel dysfunction after stoma reversal,often captured by the Low Anterior Resection Syndrome (LARS) and Wexner incontinence scores,can impair quality of life. We assessed whether pre-closure high-resolution anorectal manometry (ARM) provides clinically useful discrimination of post-closure functional outcomes.

In this single-centre retrospective pilot, ten consecutive adults undergoing planned stoma reversal had pre-closure ARM with anal resting pressure (RP) and maximal squeeze pressure (SP). Post-closure outcomes were LARS and Wexner scores; major LARS was defined as ≥30 and major incontinence as Wexner ≥11. Continuous data are reported as median (IQR). Discrimination was evaluated with ROC curves.We also explored Pearson correlations and Mann–Whitney U tests, and examined the association between the rectoanal inhibitory reflex (RAIR) and major incontinence (Wexner ≥11) using Fisher’s exact test.

The cohort was 70% male with a median age of 59 years (48.2–61.8). Surgical indications comprised rectal cancer (6/10), Fournier’s gangrene (2/10), Crohn’s disease (1/10), and colon cancer (1/10).Median RP and SP were 31 mmHg (22–59) and 77 mmHg (67–98), respectively. LARS categories were <20 in 1/10, 20–29 in 7/10, and ≥30 in 2/10; major Wexner occurred in 4/10. For predicting major LARS, RP showed moderate discrimination (AUC 0.69) with an approximate optimal threshold of 29 mmHg (sensitivity 1.00, specificity 0.50), while SP yielded an AUC of 0.72 with an optimal threshold around 286.5 mmHg (sensitivity 0.50, specificity 1.00). Against major Wexner, discrimination was weaker (RP AUC 0.54; SP AUC 0.60). Pearson correlations between pressures and both LARS and Wexner were not statistically significant, and Mann–Whitney U comparisons showed no significant group differences. RAIR absence tended to coincide with a higher rate of major incontinence (66.7% [2/3] vs 28.6% [2/7]); Fisher’s exact test gave an odds ratio of 5.0 (p=0.50). Confidence intervals were wide across analyses, reflecting the small sample and low number of positive events.

In this pilot series, pre-closure ARM,particularly resting pressure,offers only modest ability to distinguish patients at risk of post-closure functional impairment, while discrimination against major Wexner incontinence is limited. RAIR absence may signal higher incontinence risk, but the study is underpowered. These hypothesis-generating findings merit confirmation in larger, preferably multicentre, cohorts and may help refine clinically meaningful thresholds for decision-making before stoma reversal.