Abstract
The results of rectal excision with colonic pouch-anal anastomosis are reviewed from a series of 162 patients covering 7 years. All patients have been operated upon in the same institution and consecutively. The follow-up is now sufficient to allow an accurate evaluation of the outcome of the patients. The main goal of this study was to provide a detailed report of the functional results. Continence was satisfactory in 96% of the patients, with either a perfect continence or minor troubles that would not have been detectable other than by a rigorous questioning. The mean number of bowel movements was 2 per 24 hours. Fragmentation of the defecation and urgency were absent. Twenty-five per cent of the patients had to elicit the evacuation of the reservoir with a suppository or an enema. Improvement of function yielded by a reservoir over straight colo-anal and low colo-rectal anastomoses are significant and, as suggested by manometric studies, are directly related to the restoration of a reservoir function.
Résumé
Les résultats fonctionnels d'une série de 162 patients consécutifs, opérés pour cancer rectal dans le même service pendant une période de 7 ans, sont présentés. Tous ces patients ont eu une résection rectale suivie d'une anastomose coloanale avec résevoir. La continence était jugée satisfaisante (continence parfaite ou troubles mineurs passant inapercus en dehors d'un interrogatoire poussé) chez 96% des patients. Le nombre moyen de selles par 24 heures était de deux. Aucun patient ne s'est plaint de fragmentation de selles ou de besoins impérieux. Vingt pour-cent des patients éprouvaient le besoin de provoquer l'évacuation de leur résevoir soit par un suppositoire, soit par un lavement. L'amélioration de la continence par l'anastomose colo-anale avec résevoir, par rapport à l'anastomose colo-anale sans résevoir ou par rapport à une anastomose colorectale basse, est nette et semble être directement en rapport avec la création de ce résevoir.
Resumen
Se revisan los resultados de la resección rectal con anastomosis colónica a bolsa anal en una serie de 162 pacientes en el curso de siete años. Todos los pacientes fueron operados en la misma institución y en forma consecutiva. El período de seguimiento ya es suficiente para permitir una evaluación certera de los resultados en tales pacientes. El propósito principal de este estudio fué el de proveer un reporte detallado de los resultados funcionales. La continencia anal apareció satisfactoria en 96% de los pacientes, con continencia perfecta o con problemas menores que no habrían sido detectables sino bajo interrogatorio riguroso. El número promedio de defecaciones fué de 2/24 horas. No se observaron fragmentación de la defecación ni sensación de urgencia. Veinticinco por ciento de los pacientes tuvo que provocar la evacuación del reservorio mediante un supositorio o un enema. Es significativa la mejoría de la función que provee un reservorio en comparación con la anastomosis directa colo-anal o con las anastomosis colo-rectales bajas, y según lo sugieren estudios manométricos está directamente relacionada con la restauración de función de reservorio.
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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. 16, 470–477 (1992). https://doi.org/10.1007/BF02104450
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DOI: https://doi.org/10.1007/BF02104450