Assessing the Postoperative Patient with Evacuatory Dysfunction: Disordered Defecation of the Neorectum and Neorectal Reservoir

  • Tracy L. Hull


Miraculous advances in surgical techniques have prevented countless patients from living with a permanent stoma after rectal resection or total proctocolectomy. When counseling patients preoperatively, it is important to communicate realistic functional expectations because surgery is not perfect and nearly all surgeries have some element of defecation dysfunction afterwards. Postoperatively, it is essential to work with patients to individualize treatment régimes. In turn, this will optimize their function and quality of life. Not every patient will achieve satisfactory results, and some will require a permanent stoma to improve their quality of life.

When performing pelvic ileal pouches, awareness and counseling of the array of possible complications is necessary. Diligent evaluation when problems are suspected can frequently locate and treat the culprit. This is essential in order to prevent permanent problems in the pouch. Redo pouches are clearly feasible if the surgical expertise exists; therefore, this type of redo surgery should only be attempted by committed surgeons and motivated patients.


Portal Vein Thrombosis Ileal Pouch Coloanal Anastomosis Permanent Stoma Pouch Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ortiz H and Armendariz P. Anterior resection: do the patients perceive any clinical benefit? Int J Colorectal Dis. 1996;11:191–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Joo JS, Latulippe JF, Alabaz O, Weiss EG, Nogueras JJ, and Wexner SD. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch. Dis Colon Rectum. 1998;41:740–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Williamson MER, Lewis WG, Finan PJ, Miller AS, Holdsworth PJ, and Johnston D. Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma; myth or reality? Dis Colon Rectum. 1995;38:411–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Horgan PG, O’Connell PR, Shinkwin CA, and Kirwan WO. Effect of anterior resection on anal sphincter function. Br J Surg. 1989;76:783–6.PubMedGoogle Scholar
  5. 5.
    Molloy RG, Moran KT, Coulter J, Waldron R, and Kirwan WO. Mechanism of sphincter impairment following low anterior resection. Dis Colon Rectum. 1992;35:462–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Williams N and Seow-Choen F. Physiological and functional outcome following ultra-low anterior resection with colon pouch-anal anastomosis. Br J Surg. 1998;85:1029–35.PubMedCrossRefGoogle Scholar
  7. 7.
    Miller AS, Lewis WG, Williamson MER, Holdsworth PJ, Johnston D, and Finan PJ. Factors that influence the outcome after coloanal anastomosis for carcinoma of the rectum. Br J Surg. 1995;82:1327–30.PubMedGoogle Scholar
  8. 8.
    O’Riordain MG, Molloy RG, Gillen P, Horgan A, and Kirwan WO. Rectoanal inhibitory reflex following low stapled anterior resection of the rectum. Dis Colon Rectum. 1992;35:874–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Lazorthes F, Fages P, Chiotasso P, Lemozy J, and 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.PubMedGoogle Scholar
  10. 10.
    Parc R, Tiret E, Frileux P, Moszkowski E, and Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg. 1986;73:139–41.PubMedGoogle Scholar
  11. 11.
    Ho YH, Tan M, and Seow-Choen F. Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomosis. Br J Surg. 1996;83:978–80.PubMedGoogle Scholar
  12. 12.
    Hallbook O, Påhlman L, Krog M, Wexner SD, and Sjodahl R. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg. 1996;224:58–65.PubMedCrossRefGoogle Scholar
  13. 13.
    Harris CJ, Lavery IC, and Fazio VW. Function of a colonic J pouch continues to improve with time. Br J Surg. 2001;88:1623–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Lazorthes, Gamagami R, Chiotasso P, Istvan G, and Muhammad S. Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis. Dis Colon Rectum. 1997;40:1409–13.PubMedCrossRefGoogle Scholar
  15. 15.
    Hida J, Yasutomi M, Fujimoto K, Okuno K, Leda S, Machidera N, Kubo R, Shindo K, and Koh K. 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.PubMedCrossRefGoogle Scholar
  16. 16.
    Hida J, Yasutomi M, Maruyama T, Tokoro T, Uchida T, Wakano T, and Kubo R. Horizontal inclination of the longitudinal axis of the colonic J-pouch: defining causes of evacuation difficulty. Dis Colon Rectum. 1999;42:1560–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Ortiz H, Miguel MD, and Armendariz P. Coloanal anastomosis: are functional results better with a pouch. Dis Colon Rectum. 1995;38:375–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Hallbook O, Nystrom P, and Sjodahl R. Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer. Dis Colon Rectum. 1997;40:332–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Hallbook O, Johansson K, and Sjodahl R. Laser Doppler blood flow measurement in rectal resection for carcinoma—comparison between the straight and colonic J-pouch reconstruction. Br J Surg. 1996;83:389–92.PubMedGoogle Scholar
  20. 20.
    Harris GJ, Lavery IJ, and Fazio VW. Reasons for failure to construct the colonic J pouch. What can be done to improve the size of the neorectal reservoir should it occur? Dis Colon Rectum. 2002;45:1304–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Z’graggen K, Maurer CA, Mettler D, Stoupis C, Wildi S, and Buchler MW. A novel colonic reservoir for rectal construction: description of the technique. Gastroenterology. 1997;112:A1487.CrossRefGoogle Scholar
  22. 22.
    Mantyh CR, Hull TL, and Fazio VW. Coloplasty in low colorectal anastomosis: manometric and functional comparison to straight and colonic J pouch anastomosis. Dis Colon Rectum. 2001;44:37–42.PubMedCrossRefGoogle Scholar
  23. 23.
    Zutshi M, Remzi F, Lavery I, Hull T, Senagore A, Church J, Strong S, Delaney C, and Fazio V. Functional outcome and complications of coloplasty pouch for low coloanal and colorectal anastomosis. Podium presentation at American Society of Colon and Rectal Surgeons; 2002 Jun 6; Chicago, Illinois.Google Scholar
  24. 24.
    Fürst A, Suttner S, Agha A, Beham A, and Jauch K-W. Colonic J-pouch vs. coloplasty following resection of distal rectal cancer. Early results of a prospective, randomized, pilot study. Dis Colon Rectum. 2003;46:1161–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Ziv Y, Fazio VW, Church JM, Lavery IC, King T, and Ambrosetti P. Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis. Am J Surg. 1996;171:320–3.PubMedCrossRefGoogle Scholar
  26. 26.
    MacRae HM, McLeod RS, Cohen Z, O’Connor BI, and Ton ENC. Risk factors for pelvic pouch failure. Dis Colon Rectum. 1997;40:257–62.PubMedCrossRefGoogle Scholar
  27. 27.
    Belliveau P, Trudel J, Vasilevsky C, Stein B, and Gordon PH. Ileoanal anastomosis with reservoirs: complications and long-term results. Can J Surg. 1999;42:345–52.PubMedGoogle Scholar
  28. 28.
    Zinicola R, Wilkinson KH, and Nicholls RJ. Ileal pouch-vaginal fistula treated by abdominoanal advancement of the ileal pouch. Br J Surg. 2003;90:1434–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Nicholls RJ. Personal communication. 1998.Google Scholar
  30. 30.
    Dayton MT and Larsen KP. Outcome of pouch-related complications after ileal pouch-anal anastomosis. Am J Surg. 1997;174:728–32.PubMedCrossRefGoogle Scholar
  31. 31.
    Johnson E, Carlsen E, Nazir M, and Nygaard K. Morbidity and functional outcome after restorative proctocolectomy for ulcerative colitis. Eur J Surg. 2001;167:40–5.PubMedGoogle Scholar
  32. 32.
    Beart R. Ulcerative colitis: complications of pelvic pouch. In: Fazio VW, editor. Current therapy in colon and rectal surgery. Philadelphia: BC Decker; 1990. pp. 180–2.Google Scholar
  33. 33.
    Whitlow CB, Opelka FG, Gathright JB, and Beck DE. Treatment of colorectal and ileoanal anastomotic sinuses. Dis Colon Rectum. 1997;40:760–3.PubMedCrossRefGoogle Scholar
  34. 34.
    Breen EM, Schoetz DJ, Marcello PW, Roberts PL, Coller JA, Murray JJ, and Rusin LC. Functional results after perineal complications of ileal pouch-anal anastomosis. Dis Colon Rectum. 1998;41:691–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Ozuner G, Hull T, Lee P, and Fazio VW. What happens to a pelvic pouch when a fistula develops? Dis Colon Rectum. 1997;40:543–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Remzi FH, Fazio VW, Oncel M, Baker ME, Church JM, Ooi BS, Connor JT, Preen M, and Einstein D. Portal vein thrombi after restorative proctocolectomy. Surgery. 2002;132;655–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Thompson-Fawcett MW, Jewell DP, and Mortensen NJ. Ileoanal reservoir dysfunction: a problem-solving approach. Br J Surg. 1997;84:1351–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Cohen Z, Smith D, and McLeod R. Reconstructive surgery for pelvic pouches. World J Surg. 1998;22:342–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Fazio VW, Wu JS, and Lavery IC. Repeat ileal pouch-anal anastomosis to salvage septic complications of pelvic pouches: clinical outcome and quality of life assessment. Ann Surg. 1998;228:588–97.PubMedCrossRefGoogle Scholar
  40. 40.
    Dayton MT. Redo ileal pouch-anal anastomosis for malfunctioning pouches—acceptable alternative to permanent ileostomy? Am J Surg. 2000;180:561–565.PubMedCrossRefGoogle Scholar
  41. 41.
    Ogunbiyi OA, Korsgen S, and Keighley MR. Pouch salvage. Long-term outcome. Dis Colon Rectum. 1997;40:548–52.PubMedCrossRefGoogle Scholar
  42. 42.
    Gemlo BT, Wong DW, Rothenberger DA, and Goldberg SM. Ileal pouch-anal anastomosis: patterns of failure. Arch Surg. 1992;127:784–7.PubMedGoogle Scholar
  43. 43.
    Foley EF, Schoetz DJ, and Roberts PL. Rediversion after ileal pouch-anal anastomosis: causes of failures and predictors of subsequent pouch salvage. Dis Colon Rectum. 1995;38:793–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Simchuk EJ and Thirlby RC. Risk factors and true incidence of pouchitis in patients after ileal pouch-anal anastomoses. World J Surg. 2000;24:851–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Heuschen UA, Allemeyer EH, Hinz U, Autschback F, Uehlein T, Herfarth C, and Heuschen G. Diagnosing pouchitis: comparative validation of two scoring systems in routine follow-up. Dis Colon Rectum. 2002;45:776–88.PubMedCrossRefGoogle Scholar
  46. 46.
    Meagher AP, Farouk R, and Dozois RR. J ileal pouch-anal anastomosis for chronic ulcerative colitis: complications and long-term outcome in 1 310 patients. Br J Surg. 1998;85:800–3.PubMedCrossRefGoogle Scholar
  47. 47.
    Stocchi L and Pemberton JH. Pouch and pouchitis. Gastroenterol Clin North Am. 2001;30:223–41.PubMedCrossRefGoogle Scholar
  48. 48.
    Merrett MN, Soper N, Mortensen N, and Jewell DP. Intestinal permeability in the ileal pouch. Gut. 1996;39:226–30.PubMedGoogle Scholar
  49. 49.
    Shen B, Achkar JP, Lashner BA, Ormsby AH, Brzezinski A, Soffer EE, Remzi RH, Bevins CL, and Fazio VW. Irritable pouch syndrome: a new category of diagnosis for symptomatic patients with ileal pouch-anal anastomosis. Am J Gastroenterol. 2002;97:972–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2005

Authors and Affiliations

  • Tracy L. Hull
    • 1
  1. 1.Department of Colorectal SurgeryCleveland Clinic FoundationClevelandUSA

Personalised recommendations