[Colo-anal pouch after total rectum resection]

Abstract

The coloanal anastomosis is in low rectal cancer for oncological reason the appropriate procedure, if the sphincter is not involved, but is followed often by impaired continence. For better continence a colonic-J-pouch anal anastomosis was performed in 11 consecutive operated patients after rectal resection predominantly for rectal cancer. The clinical and physiological results in 10 out of 11 patients having a colonic-J-pouch anastomosis (CPA) and in 11 out of 21 patients having a straight coloanal anastomosis (SAA) were compared. 1 CPA patient and 2 SAA patients were incontinent. 7 SAA and no CPA patient had minor incontinence. 9 CPA and 2 SAA patients were fully continent. The stoolfrequency per 24 hours was 3 in the CPA while it was 6 in SAA on average (p < 0.005) 5 months after closure of the protective colostomy. There was no significant difference in anal resting pressure and squeeze pressure and in the frequency of the sphincterinhibitory reflex in the two groups. The compliance was different in both groups (4.4 in CPA vs 1.9 in SAA patients) but not significantly. The patients with a colonic J-pouch had a better continence than the patients with a straight coloanal anastomosis. The better continence is associated with an higher compliance, which results in a more favorable reservoir function.