Comparison of colonic J-pouch reconstruction and straight coloanal anastomosis after intersphincteric rectal resection

Abstract

The tendency towards sphincter-preserving resection for distal rectal cancers has led to the technique of straight coloanal anastomosis (CAA) and colonic J-pouch anal anastomosis (CPA) after low anterior resection. The aim of the present study was to compare complication rate, anorectal physiology and functional results after both types of reconstruction after ultra-low intersphincteric resection. A total of 31 patients who had undergone CPA were followed up prospectively using anorectal manometry and a standardised questionnaire and were compared with 63 patients who had undergone CAA and were followed up in the same way. The complication rate after CPA did not differ significantly from that after CAA. One year postoperatively, the median stool frequency and urgency were reduced after CPA (1.7+/-2.2/day; 7% vs. 2.4+/-3.6/day; 14%; P<0.05). Three months after colostomy/ileostomy closure, the maximum tolerable volume, threshold volume and compliance were decreased after CAA when compared with CPA (55+/-12, 34+/-12, and 3.9+/-0.3 ml/mmHg vs. 85+/-21, 53+/-11 and 6.2 ml/mmHg, respectively; P<0.05). Anal manometry revealed no significant differences in the anal resting and squeeze pressure. One year postoperatively, continence also did not differ significantly between CPA and CAA. Colonic J-pouch reconstruction seems to be superior to the straight coloanal anastomosis, especially during the first postoperative year. In view of the often poor prognosis of the patients, it is the reconstruction of choice after ultra-low resections of the rectum.

Causes and Prevention of Functional Disturbances Following Low Anterior Resection for Rectal Cancer

“…In 11 out of 12 controlled studies (5,40,43,52,54,64,49,102,143,160,162), compliance was higher in the pouch group than in the group with straight colorectal or coloanal anastomosis, in 9 studies significantly so. In 8 studies (32,50,64,82,88,123,160,162) SV was lower in the group without pouch, the majority significantly so compared with the pouch group. The studies on volumetric parameters confirm the better reservoir function of the pouch compared with straight coloanal or colorectal anastomosis.…”

“…Retrospective studies show that more than half the patients with straight coloanal anastomosis (26,27,73,127,162,163) and about 30 to 50 % of patients with straight low colorectal anastomosis (12,14,106,107,137) suffer from continence disorders after low anterior resection. The inevitable extensive or complete loss of the rectum after LAR and TME results in reduced compliance and a decrease in maximal tolerable volume (MTV) and sensory volume (SV).…”

“…In numerous controlled studies volumetric parameters of reservoir function, such as MTV, SV and compliance, were examined. In 13 out of 16 studies a significantly higher MTV was measured in the pouch group compared with the group without a pouch ( 5,32, 43,52,54,64,69,82,86,102,118,122,123,160,162). In most studies the patients were examined one year post-operatively.…”

Komplikationen nach tiefer Rektumresektion Aspekte eines vielschichtigen Phänomens

“…kolorektalen Naht, eine postoperative Funktion erreichen lässt, die von ca. 80% der Patienten nach einer Adaptationsperiode von 9-12 Monaten als gut bis sehr gut bezeichnet wird [9,22]. Durch eine technische Variation, nämlich die Rekonstruktion mittels der sog.…”

“…Durch eine technische Variation, nämlich die Rekonstruktion mittels der sog. Kolon-J-Pouch, ist es sogar gelungen, diesen Anpassungszeitraum praktisch zu eliminieren und bereits wenige Wochen nach der Resektion wieder gute Kontinenz zu erzielen [22]. Damit Funktionsstörungen treten daneben auch infolge einer prä-oder postoperativen Bestrahlung auf [5,14].…”