Abstract
PURPOSE: Surgical options in metachronous or recurrent rectal cancer after anterior or low anterior resection are limited and frequently result in abdominoperineal rectal extirpation sacrificing the sphincter or in straight coloanal reconstruction. Decreased capacity and distensibility in straight coloanal reconstruction after proctectomy correlate well with increased daily stool frequency, urgency, and incontinence. A new technique for coloanal pouch reconstruction using the ileocecal segment is proposed. METHODS: A pedunculated ileocecal segment was rotated 180° counterclockwise and placed between the sigmoid colon and anal canal. Ileal end of the pouch was then anastomosed end-to-end with the transected sigmoid colon and proximal end of the ileum with distal end of the ascending colon. Functional results and defecation quality of a 67-year-old woman are described 6 and 12 months after ileocolonic interposition pouch replacing the tumorbearing rectum. RESULTS: Twelve months postoperatively, the patient is free of disease with an excellent defecation quality, has full anal continence without soiling, is having two solid stools in 24 hours. Functional control revealed normal anal sphincter pressure and large rectal capacity and compliance. Neither outlet obstruction nor incomplete evacuation have been observed. CONCLUSION: The ileocecal interposition pouch (cecum pouch) represents an alternative technique for coloanal reconstruction in low rectal cancer, recurrent rectal cancer, or metachronous low rectal cancer with intact sphincter function. This new method presents some attractive features compared with techniques presently in use.
Similar content being viewed by others
References
Habr-Gama A. A preservaçao do aparelho esfincteriano no tratamento do câncer do reto-necassaria ou desejavel? Rev Bras Colo-Proc 1991;11:45–7.
Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum. Br J Surg 1986;73:136–8.
Parc R, Berger A, Tiret E, Frileux P, Nordlinger B, Hannoun L. Anastomose coloanale avec reservoir dans le traitement du cancer du rectum. Ann Gastroenterol Hepatol (Paris) 1987;23:329–31.
Hildebrandt U, Zuther T, Lindemann W, Ecker K. Electromyographic function of the coloanal pouch. Chir Forum Experim. u. Klinische Forschung 1993:127–31.
Berger A, Tiret E, Parc R,et al. Excision of the rectum with colonic J-pouch-anal anastomosis for adenocarcinoma of the low and mid rectum. World J Surg 1992;16:470–7.
Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986;1:1979–82.
von Flüe M, Rothenbühler JM, Hellwig A, Beglinger Ch, Harder F. The colonic J-pouch anal reconstruction after total rectal excision: functional aspects. Schweiz Med Wochenschr 1994;124:1056–63.
Kusunoki M, Shoji Y, Yanagi H, Fujita S, Hatada T. Modified anoabdominal rectal resection and colonic J-pouch-anal anastomosis for lower rectal carcinoma: preliminary report. Surgery 1992;112:876–83.
Author information
Authors and Affiliations
About this article
Cite this article
von Flüe, M., Harder, F. New technique for pouch-anal reconstruction after total mesorectal excision. Dis Colon Rectum 37, 1160–1162 (1994). https://doi.org/10.1007/BF02049823
Issue Date:
DOI: https://doi.org/10.1007/BF02049823