After ileal J pouch-anal anastomosis, a residual septum in the J reservoir occasionally causes evacuation difficulties and obstructive symptoms. In our experience, 10 of 134 ileoanal anastomosis patients developed this complication, which is known as the apical pouch bridge (APB) syndrome. In our APB syndrome patients, defecography revealed a flap valve-like movement of the mucosal bridge, a change of the ano-rectal angle, and increased residual volume. Endoscopy showed a thickened apical pouch bridge with mild inflammation. The APB syndrome features frequent stools and soiling without a significant difference on anal manometry compared to the normal group. The symptoms of this syndrome are improved by division of the mucosal bridge. This pitfall should be taken into consideration by surgeons when constructing an ileal J pouch.

Colonic J pouch anal anastomosis is widely employed after rectal resection. In the 36 patients who participated in our retrospective study, although postoperative continence was retained/maintained in each individual, a survey questionnaire indicated some difficulties in neoanorectal function. Therefore, defecography was performed in 20 of these patients. Patients experiencing soiling were found to have an increased ano-pouch angle and pelvic floor descent. Loss of sensation and incomplete evacuation were also associated with an abnormally large pelvic floor descent. However, stool frequency, urgency, and the need for medication showed no correlation with any of the defecography parameters. These findings thus suggested that the puborectal muscle and the levator ani muscle played an important role in postoperative function. Defecography was also found to provide a dynamic assessment of the postoperative state of colonanal reconstruction.