Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: Comparison of straight and colonic J pouch anastomoses

Abstract

Clinical function and anorectal physiology were studied prospectively in patients with rectal cancer after low anterior resection, randomized to either a straight anastomosis or an 8-cm colonic J pouch anastomosis. Sixteen patients (mean(s.e.m.) age 61.2(3.2) years; ten men, six women) had a straight anastomosis and 17 (mean(s.e.m.) age 61.2(3.8) years; six men, 11 women) a colonic pouch anastomosis. At 1 year after low anterior resection, a bowel function questionnaire was administered and anorectal physiology tests were performed. Patients with a straight anastomosis had significantly more frequent stools (median 6 (range 3-7) daily) compared with those who had a pouch (median 3 (range 2-7) daily; P = 0.02). A frequent sensation of incomplete defaecation was found in three patients with a straight anastomosis compared with ten who had a pouch anastomosis (P = 0.02). The mean resting anal pressures were lower after colonic pouch anastomosis (P = 0.049) but there were no differences in anal squeeze pressure, rectal sensation, volume of first sensation and compliance between the two groups. The decreased stool frequency with an 8-cm colonic pouch was not associated with measured improvements in rectal reservoir function. It is possible that reversed propulsive activity may be important in smaller colonic J pouches.

Comparing colorectal cancer treatment and survival for Aboriginal and non‐Aboriginal people in New South Wales

“…[85][86][87][88] In the largest series of 162 patients, with a maximum follow up of seven years, 25% of patients required an enema or suppository to empty the pouch. 88 A pouch length of 8-10 cm was calculated in a mathematical model to produce an ideal pouch capacity 89 although the risks of impaired emptying were not factored into this model.…”

A Randomized Multicenter Trial to Compare Long-Term Functional Outcome, Quality of Life, and Complications of Surgical Procedures for Low Rectal Cancers

“…There has been no consensus on whether the reservoir capability of the JP confers a long-term functional advantage with studies showing that it does 10,15,35 and does not 14 offer benefit beyond 24 months. In this study, the function of the JP did not decline over 24 months and was superior to that of the coloplasty pouch or the SA and conclusively proves that contrary to conventional wisdom the reservoir capability of the JP does not decline over time.…”

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

“…Building on successful experience with the ileoanal pouch in familial adenomatous polyposis and ulcerative colitis following proctocolectomy, the colonic J pouch was introduced by Lazorthes and Parc (26,125) The clinical results and manometric data have been compared with straight colorectal and coloanal anastomosis in controlled studies, including numerous randomized trials (29,33,41,54,56,63,88,100,122,123,143,146). According to a meta-analysis (49), the CJP has unique advantages compared with straight coloanal anastomosis: Bowel movement was significantly less up to 2 years after surgery, significantly fewer patients suffered from an imperative urge to defecate up to one year post-operatively and significantly fewer patients had to take antidiarrheals.…”

“…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.…”