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Enlargement of colonic pouch after proctectomy and colonanal anastomosis

Potential cause for evacuation difficulty

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

Abstract

PURPOSE: Although the functional outcome after low anterior resection for rectal cancer using colonic J-pouch reconstruction is superior to that using conventional straight reconstruction, the one drawback of colonic J-pouch reconstruction is difficulty with evacuation. Recently it has been suggested that construction of a larger colonic J-pouch causes the evacuation difficulty. The purpose of this study was to elucidate the cause of evacuation difficulty with colonic J-pouch reconstruction. METHODS: We compared pouchography of 26 patients with 10-cm colonic J-pouch reconstructions (10-J group) and 27 patients with 5-cm colonic J-pouch reconstructions (5-J group) at three months, one year, and two years after surgery. Functional assessments were performed one year postoperatively. Clinical function was evaluated using a questionnaire. Evacuation function was evaluated by the balloon expulsion and saline evacuation tests. RESULTS: The greatest width of the pouch in the 10-J group in the anteroposterior view was significantly greater than that in the 5-J group at all three measurement times (3 months, 4.9vs. 4 cm;P=0.0011; 1 year, 9vs. 5.6 cm;P<0.0001; 2 years, 9.2vs. 5.8 cm;P<0.0001). The value in the 10-J group at one year after surgery was 1.9 times that at three postoperative months; in the 5-J group this ratio was 1.4. There was a significant difference between these ratios (P<0.0001). No significant difference existed between the values at two years and one year after surgery in either the 10-J or the 5-J group. An evacuation difficulty was significantly more common in the 10-J group than the 5-J group. Evacuation function in the 10-J group was significantly inferior to that in the 5-J group. CONCLUSIONS: The evacuation difficulty observed in patients with larger colonic J-pouch reconstructions is associated with excessive distention of the pouch occurring within one year of surgery.

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References

  1. 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 

  2. Parc P, 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 

  3. Drake DB, Pemberton JH, Beart RW Jr, Dozois RR, Wolff BG. Coloanal anastomosis in the management of benign and malignant rectal disease. Ann Surg 1987;206:600–5.

    Google Scholar 

  4. 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 

  5. 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 

  6. 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 

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

    Google Scholar 

  8. Leo E, Belli F, Baldini MT,et al. New perspective in the treatment of low rectal cancer: total rectal resection and coloendoanal anastomosis. Dis Colon Rectum 1994;37(Suppl):S62–8.

    Google Scholar 

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

    Google Scholar 

  10. Ramirez JM, Mortensen NJ, Takeuchi N, Smilgin Humphreys MM. Colonic J-pouch rectal reconstruction: is it really a neorectum? Dis Colon Rectum 1996;39:1286–8.

    Google Scholar 

  11. Ramanos J, Stebbing JF, Smilgin Humphreys MM, Takeuchi N, Mortensen NJ. Ambulatory manometric examination in patients with a colonic J pouch and in normal controls. Br J Surg 1996;83:1744–6.

    Google Scholar 

  12. 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 

  13. Hida J, Yasutomi M, Fujimoto K,et al. Functional outcome after low anterior resection for rectal cancer using the colonic J-pouch. Surg Today 1997;27:1109–12.

    Google Scholar 

  14. 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 

  15. 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.

    Google Scholar 

  16. 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.

    Google Scholar 

  17. 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.

    Google Scholar 

  18. 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.

    Google Scholar 

  19. 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.

    Google Scholar 

  20. 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.

    Google Scholar 

  21. 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.

    Google Scholar 

  22. 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.

    Google Scholar 

  23. Sobin LH, Wittekind C (International Union Against Cancer), eds. TNM Classification of malignant tumours. 5th ed. New York: Wiley-Liss, 1997:66–9.

    Google Scholar 

  24. 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.

    Google Scholar 

  25. Pescatori M, Manhire A, Bartram CI. Evacuation pouchography in the evaluation of ileoanal reservoir function. Dis Colon Rectum 1983;26:365–8.

    Google Scholar 

  26. Tsao JI, Galandiuk S, Pemberton JH. Pouchogram: predictor of clinical outcome following ileal pouch-anal anastomosis. Dis Colon Rectum 1992;35:547–51.

    Google Scholar 

  27. 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.

    Google Scholar 

  28. Stelzner M, Fonkalsrud EW, Lichtenstein G. Significance of reservoir length in the endorectal ileal pullthrough with ileal reservoir. Arch Surg 1988;123:1265–8.

    Google Scholar 

  29. Hennild V, Kjærgård H, Hansen LK. Radiologic evaluation of the continent (S-pouch) ileal reservoir with anal anastomosis. Acta Radiol [Diagn] 1986;27:301–4.

    Google Scholar 

  30. Hillard AE, Mann FA, Becker JM, Nelson JA. The ileoanal J pouch: radiographic evaluation. Radiology 1985;155:591–4.

    Google Scholar 

  31. Kremers PW, Scholz FJ, Schoetz DJ Jr, Veidenheimer MC, Coller JA. Radiology of the ileoanal reservoir. AJR Am J Roentgenol 1985;145:559–67.

    Google Scholar 

  32. 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.

    Google Scholar 

  33. Becker JM. Anal sphincter function after colectomy, mucosal proctectomy, and endorectal ileoanal pull-through. Arch Surg 1984;119:526–31.

    Google Scholar 

  34. Metcalf AM, Dozois RR, Kelly KA, Beart RW Jr, Wolff BG. Ileal. “J” pouch-anal anastomosis: clinical outcome. Ann Surg 1985;202:735–9.

    Google Scholar 

  35. Becker JM, Raymond JL. Ileal pouch-anal anastomosis: a single surgeon's experience with 100 consecutive cases. Ann Surg 1986;204:375–83.

    Google Scholar 

  36. Öresland T, Fasth S, Nordgren S, Åkervall S, Hultén L. Pouch size: the important functional determinant after restorative proctocolectomy. Br J Surg 1990;77:265–9.

    Google Scholar 

  37. Chaussade S, Michopoulos S, Hautefeuille M,et al. Clinical and physiological study of anal sphincter and ileal J pouch before preileostomy closure and 6 and 12 months after closure of loop ileostomy. Dig Dis Sci 1991;36:161–7.

    Google Scholar 

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Authors and Affiliations

  1. First Department of Surgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan

    Jin-ichi Hida M.D., Masayuki Yasutomi M.D., Takamasa Maruyama M.D., Tadao Tokoro M.D., Tsukasa Wakano M.D. & Toshihiro Uchida M.D.

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  1. Jin-ichi Hida M.D.
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  2. Masayuki Yasutomi M.D.
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  3. Takamasa Maruyama M.D.
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  4. Tadao Tokoro M.D.
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  5. Tsukasa Wakano M.D.
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  6. Toshihiro Uchida M.D.
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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.

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Hida, Ji., Yasutomi, M., Maruyama, T. et al. Enlargement of colonic pouch after proctectomy and colonanal anastomosis. Dis Colon Rectum 42, 1181–1188 (1999). https://doi.org/10.1007/BF02238571

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