Coloanal J-Pouch Reconstruction Following Low Rectal Resection

Abstract

From an oncological point of view, a distal resection border of 2 cm is sufficient after deep anterior rectal resection and total mesorectal excision. This conclusion has led to extending the indications for ultradeep rectal resection in recent years. The classical end-to-end coloanal anastomosis, however, has been shown to be associated with several functional drawbacks, for example, increased stool urgency and in some cases incontinence, especially in the first 6–12 months after the operation. It was to improve these aspects that the coloanal pouch was introduced.

In a pilot study we performed a coloanal pouch in 25 patients (median age 65 years, range 32–85). The coloanal pouch anastomosis was generally performed by a stapling device. A transanal hand-sewn anastomosis was performed in the section down to the sphincter level. Indications included rectal cancer, recurrent villous adenoma, and in one case recto-vaginal fistula. The pouch was also constructed by a linear stapling device, and its length was usually 5–7 cm. The level of the anastomosis averaged 2 cm above the dentate line. In 16 patients a protective ileostomy was also carried out. We observed four cases of anastomotic leak and in one an abscess. Results showed full continence after 6 months and in 85% after 1 year. Urgency was observed in four patients after 3 months, and in only one after 1 year. In summary, we obtained encouraging results for initiating a randomized trial in the future to confirm the advantages of this type of reconstruction after deep anterior rectal resection.