A new surgical concept for rectal replacement after low anterior resection: the transverse coloplasty pouch

Abstract

Objective: To analyze the feasibility, safety, complication and death rates, and early functional results of the transverse coloplasty pouch procedure after low anterior rectal resection and total mesorectal excision.

Summary background data: The authors previously developed a novel neorectal reservoir, the transverse coloplasty pouch, in an animal model; they report the first clinical data of a prospective phase 1 study.

Methods: Forty-one patients underwent low anterior rectal resection with total mesorectal excision for rectal cancer (n = 37) or benign pathology (n = 4). The continuity was restored with a transverse coloplasty pouch anastomosis, and the colon was defunctionalized for 3 months. Patients were followed up at 2-month intervals for functional outcome.

Results: Intraoperative complications occurred in three patients (7%), none related to the transverse coloplasty pouch. There were no hospital deaths and the total complication rate was 27% (11/41); an anastomotic leakage rate of 7% was recorded. The stool frequency was 3.4 per 24 hours at 2 months follow-up and gradually decreased to 2.1 per 24 hours at 8 months. Stool dysfunctions such as stool urgency, fragmentation, and incontinence grade 1 and 2 were regularly observed until 6 months; the incidence significantly decreased thereafter. None of the patients had difficulties in pouch evacuation.

Conclusions: The transverse coloplasty pouch is a small-volume reservoir that can safely be used for reconstruction after sphincter-preserving rectal resection. The early functional outcome is favorable and can be compared to other colonic reservoirs. The concept of reducing early dysfunction seen after straight coloanal anastomosis and avoiding long-term problems of pouch evacuation is supported by this study. Future trials will compare the transverse coloplasty pouch with other techniques of restorative resections of the rectum.

Figure 1. (A) The anvil of the stapler is inserted and secured by a 2-0 monofilament purse-string suture. The colon is opened longitudinally between the taenias beginning 2 cm proximal to the rim of the anvil. Lateral traction by stay sutures shows how the transverse coloplasty pouch is formed. (B) The colostomy is closed transversely by the first running suture (5-0 PDS). (C) The second running seromuscular suture line concludes the formation of the transverse coloplasty pouch, followed by the completion of the anastomosis. (A–C, copyright Karger AG, Basel, Switzerland: reference .)