Skip to main content
SpringerLink
Log in

Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch

Is the functional superiority of colonic J-pouch sustained?

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

AIM: This study was designed to analyze the functional and clinical outcomes of straight coloanal anastomosis compared with colonic J-pouch performed after low anterior resection. MATERIALS AND METHODS: Between September 1989 and June 1996, all patients who underwent low anterior resection with anastomosis less than 4 cm from the dentate line were classified into two groups based on the restoration of intestinal continuity: “straight” coloanal anastomosis (n=39) or colonic J-pouch (n=44). Both groups were assessed according to the level of anastomosis, anastomotic complications (stricture, leak, pelvic abscess), age, and gender. For comparison of functional outcome, daily bowel movements, tenesmus, urgency, incontinence score (range, 0–20), and anorectal manometric findings were evaluated preoperatively and at six months, and one and two years after surgery. RESULTS: There were no significant differences between the groups relative to age: (coloanal anastomosis, 66.3±10.1 (range, 46–86),vs. colonic J-pouch, 64.9±13.2 (range, 39–88) years); gender (females): (coloanal anastomosis, 46.2 percentvs. colonic J-pouch; 38.6 percent); diagnosis: (rectal carcinoma: coloanal anastomosis, 84.6 percent,vs. colonic J-pouch, 77.3 percent); preoperative incontinence score (coloanal anastomosis, 1.5±4.6,vs. colonic J-pouch, 1.1±4); bowel movements: (coloanal anastomosis, 2.1±2.3,vs. colonic J-pouch, 2.1±1.9/day); level of anastomosis: (coloanal anastomosis, 1.8±1.3,vs. colonic J-pouch, 1.5±1.3 cm from the dentate line); history of perioperative radiation therapy: (coloanal anastomosis, 15.4 percent,vs. colonic J-pouch, 20.5 percent); or manometric findings. There was also no significant difference in postoperative mortality: (coloanal anastomosis, 5.1 percent,vs. colonic J-pouch, 2.3 percent); or anastomotic complications: (coloanal anastomosis, 7/39 (17.9 percent),vs. colonic J-pouch, 2/44 (4.5 percent)P=0.08); strictures: (10.3vs. 0 percent); leaks: (5.1vs. 2.3 percent); bleeding: (2.6vs. 0 percent); rectovaginal fistula: (0vs. 2.3 percent). Also, in the colonic J-pouch group, two patients developed pouchitis, and one patient experienced difficult evacuation one year after surgery. There was a statistically significant better function judged by less frequent bowel movements (4±2vs. 2.4±1.3/day;P<0.005) and urgency (36.7vs. 7.7 percent;P<0.05), incontinence score (2.2±3.7vs. 0.8±1.6;P<0.05) up to one year after surgery. At two years, the coloanal anastomosis group did not show statistical improvement in functional results compared with one year postoperatively. Rectal compliance in manometric findings was significantly increased in the coloanal anastomosis group at one year after surgery (12.4±12.6vs. 4.2±1.5 ml/mmHg;P<0.05). However, these differences were less profound after two years. CONCLUSION: The functional superiority of the colonic J-pouch was greatest at one year after surgery. By two years, adaptation of the “straight” coloanal anastomosis yielded similar functional results. However, the almost fourfold reduction in anastomotic complications in the colonic J-pouch group reveals a second potential advantage of this technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. McDermott FT, Hughes ES, Phil EA,et al. Changing survival prospects in rectal carcinoma: a series of 1306 patients managed by one surgeon. Dis Colon Rectum 1986;29:798–803.

    Google Scholar 

  2. McDonald PJ, Heald RJ. A survey of postoperative function after rectal anastomosis with circular stapling device. Br J Surg 1983;70:727–9.

    Google Scholar 

  3. Williams NS, Price R, Johnston D. The long term effects of sphincter preserving operations for rectal carcinoma on function of the anal sphincter in man. Br J Surg 1980;67:203–8.

    Google Scholar 

  4. Parks AG, Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma. Br J Surg 1982;69:301–4.

    Google Scholar 

  5. Lazorthes F, Fages P, Chiotasso P, Lemozy J, 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.

    Google Scholar 

  6. Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg 1986;73:139–41.

    Google Scholar 

  7. 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.

    Google Scholar 

  8. Mortensen NJ, Ramirez JM, Takeuchi N, Humphreys MM. Colonic J pouch-anal anastomosis after rectal excision for carcinoma: functional outcome. Br J Surg 1995;82:611–3.

    Google Scholar 

  9. 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.

    Google Scholar 

  10. Hallböök O, Pählman L, Krog M, Wexner SD, Sjödahl R. Randomized comparison of straight and colonic J pouch anastomosis after lower anterior resection. Ann Surg 1996;224:58–65.

    Google Scholar 

  11. Pelissier EP, Blum D, Bachour A, Bosset JF. Functional results of coloanal anastomosis with reservoir. Dis Colon Rectum 1992;35:843–6.

    Google Scholar 

  12. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97.

    Google Scholar 

  13. Wexner SD, Marchetti F, Jagelman DG. The role of sphincteroplasty for fecal incontinence reevaluated: a prospective physiologic and functional review. Dis Colon Rectum 1991;34:22–30.

    Google Scholar 

  14. Wexner SD, James K, Jagelman DG. The double-stapled ileal reservoir and ileoanal anastomosis: a prospective review of sphincter function and clinical outcome. Dis Colon Rectum 1991;34:487–94.

    Google Scholar 

  15. Orkin BA. Rectal carcinoma: treatment. In: Beck DE, Wexner SD, eds. Fundamentals of anorectal surgery. New York: McGraw-Hill, 1992:260–370.

    Google Scholar 

  16. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 1982;69:613–6.

    Google Scholar 

  17. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2:996–9.

    Google Scholar 

  18. Karanjia ND, Schache DJ, North WR, Heald RJ: ‘Close shave” in anterior resection. Br J Surg 1990;77:510–2.

    Google Scholar 

  19. Wilson SM, Beahrs OH. The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum. Ann Surg 1976;183:556–65.

    Google Scholar 

  20. Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival. Br J Surg 1983;70:150–4.

    Google Scholar 

  21. Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 1983;198:159–63.

    Google Scholar 

  22. Pezim ME, Taylor BA, Davis CJ, Beart RW Jr. Perforation of terminal ileal appendage of J-pelvic ileal reservoir. Dis Colon Rectum 1987;30:161–3.

    Google Scholar 

  23. Stryker SJ, Kelly KA, Phillips SF, Dozois RR, Beart RW Jr. Anal and neorectal function after ileal pouch-anal anastomosis. Ann Surg 1986;203:55–61.

    Google Scholar 

  24. Kusunoki M, Shoji Y, Yanagi H,et al. Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis. Br J Surg 1991;78:1434–8.

    Google Scholar 

  25. Fazio VW. Cancer of the rectum-sphincter saving operation: stapling techniques. Surg Clin North Am 1988;68:1367–82.

    Google Scholar 

  26. Wexner SD, Cohen SM. Anastomotic leakage after anterior resection. Eur J Surg 1994;160:299–300.

    Google Scholar 

  27. Baker JW. Low end to side recto-sigmoidal anastomosis: description of the technique. Arch Surg 1950;61:143–57.

    Google Scholar 

  28. Hallböök O, Johansson K, Sjödahl 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.

    Google Scholar 

  29. Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994;81:1224–6.

    Google Scholar 

  30. Graf W, Gilmelius B, Bergström R, Påhlman L. Complications after double and single stapling in rectal surgery. Eur J Surg 1991;157:543–7.

    Google Scholar 

  31. Hallböök O, Sjödahl R. Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 1996;83:60–2.

    Google Scholar 

  32. Beard JD, Nicholson ML, Sayers RD, Lloyd D, Everson NW. Intraoperative air testing of colorectal anastomosis: a prospective, randomized trial. Br J Surg 1990;77:1095–7.

    Google Scholar 

  33. Sun WM, Read NW, Katsinelos P, Donnelly TC, Short-house AJ. Anorectal function after restorative procolectomy and low anterior resection with coloanal anastomosis. Br J Surg 94;81:280–4.

  34. Joo JS, Agachan F, Weiss EG, Nogueras JJ, Wexner SD. The role of splenic flexure mobilization in anastomotic safety in anterior resection. Techniques in Coloproctology (in press).

  35. Seow-Choen F, Goh HS. Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 95;82:608–10.

  36. 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 anastomosis. Br J Surg 1996;83:978–80.

    Google Scholar 

  37. 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.

    Google Scholar 

  38. Ortiz H, De Miguel M, Armendariz P, Rodriguez J, Chocarro C. Coloanal anastomosis: are functional results better with a pouch? Dis Colon Rectum 1995;38:375–7.

    Google Scholar 

  39. Seow-Choen F. Colonic pouches in the treatment of low rectal cancer. Br J Surg 1996;83:881–2.

    Google Scholar 

  40. Cavaliere F, Pemberton JH, Cosimelli M, Fazio VW, Beart RW Jr. Coloanal anastomosis for cancer. long-term results at the Mayo and Cleveland Clinics. Dis Colon Rectum 1995;38:807–12.

    Google Scholar 

  41. Madoff RD, Orrom WJ, Rothenberger DA, Goldberg SM. Rectal compliance: a critical reappraisal. Int J Colorectal Dis 1990;5:37–40.

    Google Scholar 

  42. Lazorthes F, Chiotasso P, Gamagami 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.

    Google Scholar 

  43. 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.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, 3000 West Cypress Creek Road, 33309, Fort Lauderdale, Florida

    Jae Sik Joo M.D., Jean F. Latulippe M.D., Omer Alabaz M.D., Eric G. Weiss M.D., Juan J. Nogueras M.D. &  Steven D. Wexner M.D.

Authors
  1. Jae Sik Joo M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean F. Latulippe M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Omer Alabaz M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric G. Weiss M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan J. Nogueras M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven D. Wexner M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by a generous grant from the Caporella family.

About this article

Cite this article

Joo, J.S., Latulippe, J.F., Alabaz, O. et al. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch. Dis Colon Rectum 41, 740–746 (1998). https://doi.org/10.1007/BF02236262

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02236262

Key words

Search

Navigation