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Quality of Life, Functional Outcome, and Complications of Coloplasty Pouch After Low Anterior Resection

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  • Published:
Diseases of the Colon & Rectum

PURPOSE

The colonic J-pouch has been used to improve bowel function in patients undergoing low colorectal or coloanal anastomosis. However, a narrow pelvis, difficulties in reach, a long anal canal with prominent sphincters, or a fatty mesentery may turn this technique into a technically challenging procedure in certain patients. In these circumstances, “coloplasty” offers an alternative to a straight anastomosis. The purpose of this study was to compare the quality of life, functional outcome, and complications between patients undergoing coloplasty, colonic J-pouch, or straight anastomosis.

METHODS

Altogether, 162 patients who underwent coloanal or low colorectal anastomosis between 1998 and 2001 were studied. Data collected included demographics, length of follow-up, technique and type of anastomosis, complications, quality of life, and functional outcome. Results were analyzed according to use of a coloplasty (n = 69), colonic J-pouch (n = 43), or straight anastomosis (n = 50). The choice of the technique was based on the surgeon’s preference. Usually coloplasty or straight anastomosis was favored in male patients with a narrow pelvis or when a handsewn anastomosis was used.

RESULTS

Quality of life assessment with the short form-36 questionnaire revealed better scores in coloplasty and colonic J-pouch groups. The coloplasty (1.0 ± 1.7) and colonic J-pouch (1.0 ± 1.2) groups had fewer night bowel movements than the straight anastomosis group (1.5 ± 2.0) (P < 0.05). The coloplasty group also had fewer bowel movements per day than the straight anastomosis group (3.8 ± 2.9 vs. 4.8 ± 3.6; P < 0.05); also, less clustering and less antidiarrheal medication use were observed than in the straight anastomosis group. Colonic J-pouch patients with handsewn anastomosis had a higher anastomotic leak rate (44 percent) than the patients in the coloplasty with hand-sewn anastomosis group (3.6 percent).

CONCLUSIONS

Coloplasty seems to be a safe, effective technique for improving the outcome of low colorectal or coloanal anastomosis. It is especially applicable when a colonic J-pouch anastomosis is technically difficult.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio

    Feza H. Remzi M.D., F.A.S.C.R.S., Victor W. Fazio M.B., M.S., F.R.A.C.S., Emre Gorgun M.D., Massarat Zutshi M.D., James M. Church M.B.B.Ch., Ian C. Lavery M.B.B.S. & Tracy L. Hull M.D.

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  1. Feza H. Remzi M.D., F.A.S.C.R.S.
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  2. Victor W. Fazio M.B., M.S., F.R.A.C.S.
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  3. Emre Gorgun M.D.
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  4. Massarat Zutshi M.D.
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  5. James M. Church M.B.B.Ch.
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  6. Ian C. Lavery M.B.B.S.
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  7. Tracy L. Hull M.D.
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Correspondence to Feza H. Remzi M.D., F.A.S.C.R.S..

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Remzi, F., Fazio, V., Gorgun, E. et al. Quality of Life, Functional Outcome, and Complications of Coloplasty Pouch After Low Anterior Resection. Dis Colon Rectum 48, 735–743 (2005). https://doi.org/10.1007/s10350-004-0862-y

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  • DOI: https://doi.org/10.1007/s10350-004-0862-y

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