Diseases of the Colon & Rectum

, Volume 42, Issue 5, pp 590–595 | Cite as

Comparison of different J-pouchesvs. straight and side-to-end coloanal anastomoses

Experimental study in pigs
  • Marco Sailer
  • E. Sebastian Debus
  • Karl H. Fuchs
  • Martin Fein
  • Jörg Beyerlein
  • Arnulf Thiede
Original Contributions


PURPOSE: Functional results after low anterior resection with straight coloanal anastomosis are poor. Although certain functional aspects are improved with coloanal J-pouch anastomosis, evacuation difficulties are encountered in some of these patients. The aim of the study was to investigate the functional results of different reconstruction methods after low anterior resection in a standardized pig model. METHODS: Thirty-two adult Göttinger mini pigs were randomly assigned either to straight end-to-end (Group 1), side-to-end (Group 2), small (4-cm limb length) J-pouch (Group 3), or large (8-cm limb length) J-pouch (Group 4) coloanal anastomosis after low rectal excision. The animals were investigated 12 weeks after the operation by measuring neorectal compliance and ceruletide-induced defecation. Eight pigs without operation were used as controls (Group 5). RESULTS: Compliance was lowest in Groups 1 and 2, which were significantly different compared with both pouch designs and controls. Neorectal compliance of pigs with either small or large pouches did not differ significantly compared with one another or controls. Defecation was significantly impaired in pigs with a large pouch compared with all other groups. Pigs with side-to-end anastomoses had as rapid an evacuation as animals with straight coloanal reconstruction. CONCLUSION: Coloanal J-pouch reconstruction adequately restores reservoir capacity after low anterior resection of the rectum. From a functional point of view, side-to-end is not superior to straight coloanal anastomosis. Compared with small pouches, a large pouch design does not lead to better neorectal compliance in the pig model, whereas pouch evacuation seems to be considerably compromised.

Key words

Coloanal anastomosis Coloanal J-pouch Compliance Defecography Ceruletide 


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  1. 1.
    Batignani G, Monaci I, Ficari F, Tonelli F. What affects continence after anterior resection of the rectum? Dis Colon Rectum 1991;34:329–35.Google Scholar
  2. 2.
    Varma JS, Smith AN. Anorectal function following coloanal sleeve anastomosis for chronic radiation injury to the rectum. Br J Surg 1986;73:285–9.Google Scholar
  3. 3.
    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.Google Scholar
  4. 4.
    Hallböök O, Påhlman L, Krog M, Wexner SD, Sjödahl R. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 1996;224:58–65.Google Scholar
  5. 5.
    Seow-Choen F, Goh SH. Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 1995;82:608–10.Google Scholar
  6. 6.
    Ortiz H, De Miguel M, Armendariz P, Rodriguez J, Chocarro C. Coloanal anastomosis: are functional results better with a pouch? Dis Colon Rectum 1995;38:375–7.Google Scholar
  7. 7.
    Lazorthes F, Chiotasso P, Gamagami RA, Istvan G, Chevreau P. Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis. Br J Surg 1997;84:1449–51.Google Scholar
  8. 8.
    Kusunoki M, Yanagi H, Shoji Y, Yamamura T, Utsunomiya J. Abdominal rectal resection and colonic J pouch-anal anastomosis: 10 years' experience. Br J Surg 1997;84:1277–80.Google Scholar
  9. 9.
    Banjeree AK, Parc R. Prediction of optimum dimensions of colonic pouch reservoir. Dis Colon Rectum 1996;39:1293–5.Google Scholar
  10. 10.
    Hida J, Yasutomi M, Fujimoto K,et al. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch: prospective randomized study for determination of optimum pouch size. Dis Colon Rectum 1996;39:986–91.Google Scholar
  11. 11.
    Graf W, Ekström K, Glimelius B, Påhlman L. A pilot study of factors influencing bowel function after colorectal anastomosis. Dis Colon Rectum 1996;39:744–9.Google Scholar
  12. 12.
    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.Google Scholar
  13. 13.
    Seow-Choen F. Colonic pouches in the treatment of low rectal cancer. Br J Surg 1996;83:881–2.Google Scholar
  14. 14.
    Gross E, Amir-Kabirian H. Coloanal J-pouch following total rectal resection. Zentralbl Chir 1994;119:878–85.Google Scholar
  15. 15.
    Zollinger RM, Sheppard MH. Carcinoma of the rectum and the rectosigmoid. Arch Surg 1971;102:335–8.Google Scholar
  16. 16.
    Adloff M, Arnaud JP, Beeharry S, Turbelin JM. Side-to-end anastomosis in low anterior resection with the EEA stapler. Dis Colon Rectum 1980;23:456–8.Google Scholar
  17. 17.
    Fingerhut A, Elhadad A, Hay JM, Lacaine F, Flamant Y. Infraperitoneal colorectal anastomosis: hand-sewn versus circular staples. A controlled clinical trial. Surgery 1994;116:484–90.Google Scholar
  18. 18.
    Lazorthes F, Gamagami R, Chiotasso P, Istvan G, Muhammad S. Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis. Dis Colon Rectum 1977;40:1409–13.Google Scholar
  19. 19.
    Pelissier EP, Blum D, Bachour A, Bosset JF. Functional results of coloanal anastomosis with reservoir. Dis Colon Rectum 1992;35:843–6.Google Scholar
  20. 20.
    Nicholls RJ, Lubowski DZ, Donaldson DR. Comparison of colonic reservoir and straight colo-anal reconstruction after rectal excision. Br J Surg 1988;75:318–20.Google Scholar
  21. 21.
    Hildebrandt U, Zuther T, Lindemann W, Ecker K. Electromyographic function of the coloanal pouch. Langenbecks Arch Chir 1993;378(Suppl):136–8.Google Scholar
  22. 22.
    Hallböök O, Nyström P-O, Sjödahl R. Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer. Dis Colon Rectum 1997;40:332–8.Google Scholar
  23. 23.
    Wang J-Y, You Y-T, Chen H-H, Chiang J-M, Yeh C-Y, Tang R. Stapled colonic J-pouch-anal anastomosis without a diverting colostomy for rectal carcinoma. Dis Colon Rectum 1997;40:30–4.Google Scholar
  24. 24.
    Kusunoki M, Shoji Y, Yanagi H,et al. Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis. Br J Surg 1991;78:1434–8.Google Scholar

Copyright information

© American Society of Colon and Rental Surgeons 1999

Authors and Affiliations

  • Marco Sailer
    • 1
  • E. Sebastian Debus
    • 1
  • Karl H. Fuchs
    • 1
  • Martin Fein
    • 1
  • Jörg Beyerlein
    • 1
  • Arnulf Thiede
    • 1
  1. 1.From the Surgical DepartmentUniversity School of MedicineWürzburgGermany

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