Abstract
PURPOSE: Functional outcome after low anterior resection for rectal cancer is improved by the construction of a colonic J-pouch. One disadvantage of this type of reconstruction is evacuation difficulty, which has been associated with large pouches. The purpose of this study was to elucidate the causes of evacuation difficulty in large pouches using pouchography. METHODS: The angle between the longitudinal axis of the pouch and the horizontal line (pouch-horizontal angle) on lateral pouchography was determined in 26 patients with 10-cm J-pouch reconstructions (10-J group) and 27 patients with 5-cm J-pouch reconstructions (5-J group). Measurement were made at three months, one year, and two years after surgery. Clinical function was evaluated using a questionnaire one year postoperatively. RESULTS: The pouch-horizontal angle in the 10-J group was significantly smaller than that in the 5-J group at all three time points. In both groups the pouch-horizontal angle at one year was significantly smaller than that at three months. There were no significant differences between the pouch-horizontal angles at one and two years. An evacuation difficulty was significantly more common in the 10-J group than the 5-J group. CONCLUSIONS: The evacuation difficulty observed in patients with large colonic J-pouch reconstructions may be attributed to the development of a horizontal inclination within one year of surgery.
Similar content being viewed by others
References
Seow-Choen F, Goh HS. Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 1995;82:608–10.
Ortiz H, De Miguel M, Armendáriz P, Rodriguez J, Chocarro C. Coloanal anastomosis: are functional results better with a pouch? Dis Colon Rectum 1995;38:375–7.
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.
Ho YH, Tan M, Seow-Choen F. Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomoses. Br J Surg 1996;83:978–80.
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.
Lazorthes F, Chiotasso P, Gamagani 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.
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.
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.
Pélissier EP, Blum D, Bachour A, Bosset JF. Functional results of coloanal anastomosis with reservoir. Dis Colon Rectum 1992;35:843–6.
Hallböök O, Sjödahl R. Comparison between the colonic J pouch-anal anastomosis and healthy rectum: clinical and physiological function. Br J Surg 1997;84:1437–41.
Lazorthes F, Gamagani 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 1997;40:1409–13.
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.
Hida J, Yasutomi M, Maruyama T,et al. Indications for colonic J-pouch reconstruction after anterior resection for rectal cancer: determining the optimum level of anastomosis. Dis Colon Rectum 1998;41:558–63.
Hida J, Yasutomi M, Maruyama T, Tokoro T, Wakano T, Uchida T. Enlargement of colonic pouch after proctectomy and coloanal anastomosis: potential cause for evacuation difficulty. Dis Colon Rectum 1999;42:1181–8.
Lindquist K, Liljeqvist, Sellberg B. The topography of ileoanal reservoirs in relation to evacuation patterns and clinical functions. Acta Chir Scand 1984;150:573–9.
Sobin LH, Wittekind Ch., eds. UICC TNM Classification of malignant tumours. 5th ed. New York: Wiley-Liss, 1997:66–9.
Paty PB, Enker WE, Cohen AM, Lauwers GY. Treatment of rectal cancer by low anterior resection with coloanal anastomosis. Ann Surg 1994;219:365–73.
Sun WM, Read NW, Katsinelos P, Donnelly TC, Shorthouse AJ. Anorectal function after restorative proctocolectomy and low anterior resection with coloanal anastomosis. Br J Surg 1994;81:280–4.
Pescatori M, Manhire A, Bartram CI. Evacuation pouchography in the evaluation of ileoanal reservoir function. Dis Colon Rectum 1983;26:365–8.
Tsao JI, Galandiuk S, Pemberton JH. Pouchogram: predictor of clinical outcome following ileal pouch-anal anastomosis. Dis Colon Rectum 1992;35:547–51.
Thoeni RF, Fell SC, Engelstad B, Schrock TB. Ileoanal pouches: comparison of CT, scintigraphy, and contrast enemas for diagnosing post surgical complications. AJR Am J Roentgenol 1990;154:73–8.
Stelzner M, Fonkalsrud EW, Lichtenstein G. Significance of reservoir length in the endorectal ileal pullthrough with ileal reservoir. Arch Surg 1988;123:1265–8.
Hennild V, Kjærgård H, Hansen LK. Radiologic evaluation of the continent (S-pouch) ileal reservoir with anal anastomosis. Acta Radiol [Diagn] (Stockh) 1986;27:301–4.
Hillard AE, Mann FA, Becker JM, Nelson JA. The ileoanal J pouch: radiographic evaluation. Radiology 1985;155:591–4.
Kremers PW, Scholz FJ, Schoetz DJ Jr, Veidenheimer MC, Coller JA. Radiology of the ileoanal reservoir. AJR 1985;145:559–67.
Becker JM, Hillard AE, Mann FA, Kestenberg A, Nelson JA. Functional assessment after colectomy, mucosal proctectomy, and endorectal ileoanal pull-through. World J Surg 1985;9:598–605.
Author information
Authors and Affiliations
Additional information
Supported in part by a Grant-in-Aid for Scientific Research from the Japanese Ministry of Education, Culture and Science and a grant for Cancer Research from the Osaka Cancer Foundation.
About this article
Cite this article
Hida, Ji., Yasutomi, M., Maruyama, T. et al. Horizontal inclination of the longitudinal axis of the colonic J-pouch. Dis Colon Rectum 42, 1560–1566 (1999). https://doi.org/10.1007/BF02236207
Issue Date:
DOI: https://doi.org/10.1007/BF02236207