Abstract
The functional outcome after a low anterior resection for rectal cancer is improved by a colonic J-pouch reconstruction. One functional problem with J-pouches is difficulty in evacuation, which is more common with large reconstructions. Since rectoceles are common findings on defecography in patients with evacuation difficulties, we proposed that a rectocele-like prolapse may be thus found in patients with large J-pouches. Pouchography was used to identifya rectocele-like prolapse (RP) in 26 patients with a 10-cm J-pouch (10-J group) and 27 patients with a 5-cm J-pouch (5-J group). Pouchography was performed at 3 months, 1 year, and 2 years after surgery. Functional assessments were performed 1 year postoperatively. Clinical function was evaluated using a questionnaire. The evacuation function was evaluated by the balloon expulsion and saline evacuation test. No patients had an RP at 3 months or 1 year after surgery. An RP was significantly more common in the 10-J group than in the 5-J group at 2 years after surgery (P=0.0374). An evacuation difficulty was significantly more common in the 10-J group than in the 5-J group. The evacuation function in the 10-J group was also significantly inferior to that in the 5-J group. An RP appearing 2 years after surgery is more common in patients with evacuation difficulties and large colonic J-pouch reconstructions.
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Seow-Choen F, Goh HS (1995) Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 82:608–610
Ortiz H, De Miguel M, Armendáriz P, Rodriguez J, Chocarro C (1995) Coloanal anastomosis: are functional results better with a pouch? Dis Colon Rectum 38:375–377
Hallböök O, Påhlman L, Krog M, Wexner SD, Sjödahl R (1996) Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 224:58–65
Ho YH, Tan M, Seow-Choen F (1996) Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonie J pouch anastomoses. Br J Surg 83:978–980
Hallböök O, Nyström P-O, Sjödahl R (1997) Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer. Dis Colon Rectum 40:332–338
Lazorthes F, Chiotasso P, Gamagani RA, Istvan G, Chevreau P (1997) Late clincial outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis. Br J Surg 84:1449–1451
Mortensen NJM, Ramirez JM, Takeuchi N, Smilgin Humphreys MM (1995) Colonic J Pouch-anal anastomosis after rectal excision for carcinoma: functional outcome. Br J Surg 82:611–613
Ramanos J, Stebbing JF, Smilgin Humphreys MM, Takeuchi N, Mortensen NJM (1996) Ambulatory manometric examination in patients with a colonic J pouch and in normal controls. Br J Surg 83:1744–1746
Hallböök O, Sjödahl R (1997) Comparison between the colonic J pouch-anal anastomosis and healthy rectum: clinical and physiological function. Br J Surg 84:1437–1441
Hida J, Yasutomi M, Maruyama T, Fujimoto K, Nakajima A, Uchida T, Wakano T, Tokoro T, Kubo R, Shindo K (1998) Indications for colonic J-pouch reconstruction after anterior resection for rectal cancer: determining the optimum level of anastomosis. Dis Colon Rectum 41:558–563
Lazorthes F, Gamagani R, Chiotasso P, Istvan G, Muhammad S (1997) Prospective, andomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis. Dis Colon Rectum 40:1409–1413
Hida J, Yasutomi M, Fujimoto K, Okuno K, Ieda S, Machidera N, Kubo R, Shindo K, Koh K (1996) 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 39:986–991
Siproudhis L, Ropert A, Vilotte J, Bretagne J-F, Heresbach D, Raoul J-L, Gosselin M (1993) How accurate is clinical examination in diagnosing and quantifying pelvirectal disorders? a prospective study in a group of 50 patients complaining of defecatory difficulties. Dis Colon Rectum 36:430–438
Agachan F, Pfeifer J, Wexner SD (1996) Defecography and proctography: results of 744 patients. Dis Colon Rectum 39:899–905
Mellgren A, Bremmer S, Johansson C, Dolk A, Udén R, Ahlbäck S-O, Holmström B (1994) Defecography: results of investigations in 2816 patients. Dis Colon Rectum 37:1133–1141
Karlbom U, Påhlman L, Nilsson S, Graf W (1995) Relationships between defecographic findings, rectal emptying, and colonic transit time in constipated patients. Gut 36:907–912
UICC (1997) In: Sobin LH, Wittekind Ch (eds) TNM Classification of Malignant Tumors, 5th edn. Wiley-Liss, New York, pp 66–69
Shorvon PJ, McHugh S, Diamant NE, Somers S, Stevenson GW (1989) Defecography in normal volunteers: results and implications. Gut 30:1737–1749
Bartram CI, Turnbull GK, Lennard-Jones JE (1988) Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol 13:72–80
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This work was 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. Detection of a rectocele-like prolapse in the colonic J-pouch using pouchography: Cause or effect of evacuation diffculties?. Surg Today 29, 1237–1242 (1999). https://doi.org/10.1007/BF02482214
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DOI: https://doi.org/10.1007/BF02482214