Abstract
OBJECTIVE. The authors compared clinical bowel function and complications of a low anterior resection with either a straight or colonic J pouch anastomosis. SUMMARY BACKGROUND DATA. Urgency and frequent bowel movements after rectal resection with a low anastomosis have been related to the loss of rectal reservoir function. Reconstruction with a colonic J pouch possibly can obviate some of this dysfunction. Earlier reports have been favorable, but they must be verified in randomized trials. METHOD. One hundred patients with rectal cancer in whom a sphincter-saving procedure was appropriate were randomized to reconstruction with either a straight or a colonic J pouch anastomosis. RESULTS. The incidence of symptomatic anastomotic leakage was lower in the pouch group (2% vs. 15%, p = 0.03). Eighty-nine patients could be evaluated after 1 year. The pouch patients had significantly fewer bowel movements per 24 hours, and less nocturnal evacuations, urgency, and incontinence. Overall well-being owing to the bowel function was rated significantly higher by the pouch patients. CONCLUSION. Reconstruction with a colonic J pouch was associated with a lower incidence of anastomotic leakage and better clinical bowel function when compared with the traditional straight anastomosis. Functional superiority was especially evident during the first 2 months.
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- BAKER J. W. Low end to side rectosigmoidal anastomosis; description of technic. Arch Surg. 1950 Jul;61(1):143–157. doi: 10.1001/archsurg.1950.01250020146016. [DOI] [PubMed] [Google Scholar]
- Berger A., Tiret E., Parc R., Frileux P., Hannoun L., Nordlinger B., Ratelle R., Simon R. Excision of the rectum with colonic J pouch-anal anastomosis for adenocarcinoma of the low and mid rectum. World J Surg. 1992 May-Jun;16(3):470–477. doi: 10.1007/BF02104450. [DOI] [PubMed] [Google Scholar]
- Cohen A. M. Colon J-pouch rectal reconstruction after total or subtotal proctectomy. World J Surg. 1993 Mar-Apr;17(2):267–270. doi: 10.1007/BF01658943. [DOI] [PubMed] [Google Scholar]
- Hallbök O., Johansson K., Sjödahl R. Laser Doppler blood flow measurement in rectal resection for carcinoma--comparison between the straight and colonic J pouch reconstruction. Br J Surg. 1996 Mar;83(3):389–392. doi: 10.1002/bjs.1800830330. [DOI] [PubMed] [Google Scholar]
- Kollmorgen C. F., Meagher A. P., Wolff B. G., Pemberton J. H., Martenson J. A., Illstrup D. M. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg. 1994 Nov;220(5):676–682. doi: 10.1097/00000658-199411000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kusunoki M., Shoji Y., Yanagi H., Hatada T., Fujita S., Sakanoue Y., Yamamura T., Utsunomiya J. Function after anoabdominal rectal resection and colonic J pouch--anal anastomosis. Br J Surg. 1991 Dec;78(12):1434–1438. doi: 10.1002/bjs.1800781208. [DOI] [PubMed] [Google Scholar]
- Lazorthes F., Fages P., Chiotasso P., Lemozy J., Bloom E. Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum. Br J Surg. 1986 Feb;73(2):136–138. doi: 10.1002/bjs.1800730222. [DOI] [PubMed] [Google Scholar]
- Leo E., Belli F., Baldini M. T., Vitellaro M., Mascheroni L., Andreola S., Bellomi M., Zucali R. New perspective in the treatment of low rectal cancer: total rectal resection and coloendoanal anastomosis. Dis Colon Rectum. 1994 Feb;37(2 Suppl):S62–S68. doi: 10.1007/BF02048434. [DOI] [PubMed] [Google Scholar]
- MacFarlane J. K., Ryall R. D., Heald R. J. Mesorectal excision for rectal cancer. Lancet. 1993 Feb 20;341(8843):457–460. doi: 10.1016/0140-6736(93)90207-w. [DOI] [PubMed] [Google Scholar]
- Nicholls R. J., Lubowski D. Z., Donaldson D. R. Comparison of colonic reservoir and straight colo-anal reconstruction after rectal excision. Br J Surg. 1988 Apr;75(4):318–320. doi: 10.1002/bjs.1800750409. [DOI] [PubMed] [Google Scholar]
- Ortiz H., De Miguel M., Armendáriz P., Rodriguez J., Chocarro C. Coloanal anastomosis: are functional results better with a pouch? Dis Colon Rectum. 1995 Apr;38(4):375–377. doi: 10.1007/BF02054224. [DOI] [PubMed] [Google Scholar]
- Parc R., Tiret E., Frileux P., Moszkowski E., Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg. 1986 Feb;73(2):139–141. doi: 10.1002/bjs.1800730223. [DOI] [PubMed] [Google Scholar]
- Pedersen I. K., Christiansen J., Hint K., Jensen P., Olsen J., Mortensen P. E. Anorectal function after low anterior resection for carcinoma. Ann Surg. 1986 Aug;204(2):133–135. doi: 10.1097/00000658-198608000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pélissier E. P., Blum D., Bachour A., Bosset J. F. Functional results of coloanal anastomosis with reservoir. Dis Colon Rectum. 1992 Sep;35(9):843–846. doi: 10.1007/BF02047870. [DOI] [PubMed] [Google Scholar]
- Seow-Choen F., Goh H. S. Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg. 1995 May;82(5):608–610. doi: 10.1002/bjs.1800820511. [DOI] [PubMed] [Google Scholar]
- Williams N. S., Price R., Johnston D. The long term effect of sphincter preserving operations for rectal carcinoma on function of the anal sphincter in man. Br J Surg. 1980 Mar;67(3):203–208. doi: 10.1002/bjs.1800670313. [DOI] [PubMed] [Google Scholar]
- Williams N. S. The rationale for preservation of the anal sphincter in patients with low rectal cancer. Br J Surg. 1984 Aug;71(8):575–581. doi: 10.1002/bjs.1800710802. [DOI] [PubMed] [Google Scholar]
- Williamson M. E., Lewis W. G., Holdsworth P. J., Finan P. J., Johnston D. Decrease in the anorectal pressure gradient after low anterior resection of the rectum. A study using continuous ambulatory manometry. Dis Colon Rectum. 1994 Dec;37(12):1228–1231. doi: 10.1007/BF02257786. [DOI] [PubMed] [Google Scholar]
- Zollinger R. M., Sheppard M. H. Carcinoma of the rectum and the rectosigmoid. A review of 729 cases. Arch Surg. 1971 Apr;102(4):335–338. doi: 10.1001/archsurg.1971.01350040097019. [DOI] [PubMed] [Google Scholar]