Advances in Abdominal Surgery 2002 pp 213-223 | Cite as
Different Role of the Colonic Pouch after Low Anterior Resection or Coloanal Anastomosis
Abstract
Functional outcome after sphincter-saving operations can be improved by colonic pouch reconstruction, compared to the straight procedure. However, it is not clear whether the colonic pouch has a different behaviour in patients who underwent low anterior resection (LAR) or coloanal anastomosis (CAA).
Material and methods: 75 patients submitted to a sphincter-saving operation for rectal carcinoma or villous tumor of the middle or lower third of the rectum, were available for the study: 18 patients underwent coloanal anastomosis (CAA), 13 of whom had a colonic pouch construction (PCAA), 20 pts underwent low anterior resection (LAR), and 24 pouch low anterior resection (PLAR). The two groups of patients were similar in age and gender. Anorectal function was studied in 13 patients submitted PLAR, in 20 patients with straight LAR, in 7 with PCAA and in 18 with CAA. Patients were re-assessed 12 months after the initial operation, by an interview and anorectal manometry.
Results: The mean number of defecations/24h were significantly higher in LAR patients 4.1 ± 0.7 versus 2.0 ± 1.5 in CAA patients, 2.2 ± 1 in patients with PCAA and 2.3 ± 1.8 in PLAR patients (p<0.05 when LAR group is compared to the other groups). Fecal soiling was observed in all the groups except in the PLAR. Less degree of incontinence or urgency were present in PCAA than in CAA. There were no differences in anal resting pressure (ARP) and squeeze pressure among the various groups. A greater distensibility and compliance of the neo-rectum was observed in CAA, PCAA, and PLAR, compared to LAR, respectively 8.5 ± 7 mmHg/ml air for CAA, 8.7 ± 5 mmHg/ml air for PCAA; 6.3 ± 4 mmHg/nil air for PLAR versus 3.1 ± 2.7 mmHg/ml air for LAR. A significative inverse linear correlation was present between the mean number of defecations24/h and the compliance. No difference of sense of incomplete evacuation was observed among the group of patients.
Conclusion: Colonic J pouch provides an advantage over straight anastomosis in sphincter-saving operation, reducing the number of defecations, fecal soiling and urgency. The role of the pouch seems to be different in LAR compared to CAA. In fact in LAR the use of the pouch increases compliance and consequently decrease the number of defecations. In CAA the pouch does not improve the number of defecations and compliance, but reduces fecal soiling and urgency.
Keywords
Maximum Voluntary Contraction Dentate Line Internal Sphincter Coloanal Anastomosis Rectal StumpPreview
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