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Clinical Trial
. 2002 Jul;236(1):49-55.
doi: 10.1097/00000658-200207000-00009.

Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates

Yik-Hong Ho  1 , Steven Brown, Siu-Meng Heah, Charles Tsang, Francis Seow-Choen, Kong-Weng Eu, Choong Leong Tang
Affiliations
Clinical Trial

Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates

Yik-Hong Ho et al. Ann Surg. 2002 Jul.

Abstract

Objective: To assess the efficacy of a novel coloplasty colonic pouch design in optimizing bowel function after ultralow anterior resection.

Summary background data: A colonic J-pouch may reduce excessive stool frequency and incontinence after anterior resection, but at the risk of evacuation problems. Experimental surgery on pigs has suggested that a coloplasty pouch (CP) may be a useful alternative. Although CP has recently been shown to be feasible in patients, there is no randomized controlled trial comparing bowel function with the J-pouch.

Methods: After anterior resection for cancer, patients were allocated to either J-pouch or CP-anal anastomoses. Continence scoring, anorectal manometry, and endoanal ultrasound assessments were made before surgery. All complications were recorded, and these preoperative assessments were repeated at 4 months. The assessments were repeated again at 1 year, and a quality of life questionnaire was added.

Results: Eighty-eight patients were recruited from October 1998 to April 2000. Both groups were well matched for age, gender, staging, adjuvant therapy, and mean follow-up. There were no differences in the intraoperative time and hospital stay. CP resulted in more anastomotic leaks. At 4 months, J-pouch patients had 10.3% less stool fragmentation but poorer stool deferment and more nocturnal leakage. However, there were no differences in the bowel function, continence score, and quality of life at 1 year. There were no differences in the anorectal manometry and endoanal ultrasound findings.

Conclusions: Coloplasty pouches resulted in more anastomotic leaks and minimal differences in bowel function. At present, the J-pouch remains the benchmark for routine clinical practice, and due care (including defunctioning stoma) should be exercised in situations requiring CP.

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Figures

None
Figure 1. Coloplasty pouch construction from descending colon.
See this image and copyright information in PMC

References

    1. Ho Y-H, Low D, Goh HS. Bowel function survey after segmental colorectal resection. Dis Colon Rectum 1996; 38: 307–310. - PubMed
    1. Williamson ME, Lewis WG, Holdsworth PJ, et al. Decrease in anorectal pressure gradient after low anterior resection of the rectum: a study using continuous ambulatory manometry. Dis Colon Rectum 1994; 37: 1228–1231. - PubMed
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    1. Ho Y-H, Tsang C, Tang CL, et al. Anal sphincter injuries from stapling instruments introduced transanally. Randomized, controlled study with endoanal ultrasound and anorectal manometry. Dis Colon Rectum 2000; 43: 169–173. - PubMed
    1. Ho Y-H, Tan M, Leong A, et al. Anal pressures impaired by stapler insertion during colorectal anastomosis: a randomized, controlled trial. Dis Colon Rectum 1999; 42: 89–95. - PubMed

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