Skip to main content

Advertisement

SpringerLink
Log in

Large contractions in the colonic J-pouch as a possible cause of incomplete evacuation

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background and aim

Restoration of neo-rectal capacity is of importance in obtaining better bowel function after low anterior resection for rectal carcinoma. However, evacuatory disorders, such as incomplete evacuation, have been reported in some patients undergoing colonic J-pouch reconstruction. Therefore, we conducted this study to explore the possible factor affecting incomplete evacuation following low anterior resection for rectal carcinoma.

Patients/methods

The subjects were 37 consecutive patients who had undergone low anterior resection for rectal tumor (colonic J-pouch in 13 patients, straight anastomosis in 24). Clinical and physiological outcomes were determined at a mean follow-up time of 12 months after the operation, and the parameters were compared between patients with and without postoperative incomplete evacuation.

Results

Although anastomosis level from the anal verge was lower in the J-pouch group (6.5 cm vs 3.9 cm, P<0.05), there was no significant difference between J-pouch and straight reconstruction regarding clinical and physiological outcomes. Postoperative incomplete evacuation was significantly more frequent in the J-pouch group than in the straight group (46% vs 25%, P<0.05). Postoperative large contractions on ano-rectal manometry were also significantly more apparent in the J-pouch group than in the straight group (31% vs 4%, P<0.05). Presence of postoperative large contractions (P=0.004), anastomotic stricture (P=0.019) and smaller postoperative maximum tolerable volume (P=0.009) were significantly and independently associated with incomplete evacuation by multivariate analysis.

Conclusion

Colonic J-pouch reconstruction following ultra-low anterior resection was comparable with higher level straight anastomosis from the clinical and physiological point of view. The presence of large contractions might be an important indicator of incomplete evacuation in patients who are undergoing rectal resection.

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

Fig. 1

Similar content being viewed by others

References

  1. Dannet ER, Parry BR (1999) Misconceptions about colonic J pouch. What the accumulating data show. Dis Colon Rectum 42:804–811

    PubMed  Google Scholar 

  2. Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J (1986) Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg 73:139–141

    CAS  PubMed  Google Scholar 

  3. Kusunoki M, Shoji Y, Yanagi H, Hatada T, Fujita S, Sakanoue Y, Yamamura T, Utsunomiya J (1991) Function after anoabdominal rectal resection and colonic J pouch-anal anastomosis. Br J Surg 78:1434–1438

    CAS  PubMed  Google Scholar 

  4. 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

    CAS  PubMed  Google Scholar 

  5. Ho YH, Tan M, Seow-chen F(1996) Prospective randomised controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomoses. Br J Surg 83:978–980

    CAS  PubMed  Google Scholar 

  6. Hida J, Yasutomi M, Fujimoto K, Okuno K, Ieda S, Machidera N, Kubo R, Sindo 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

    CAS  PubMed  Google Scholar 

  7. Hida J, Yasutomi M, Maruyama T, Tokoro T, Uchida T, Wakano T, Kubo R (1999) Horizontal inclination of the longitudinal axis of the colonic J-pouch. Defining causes of evacuation difficulty. Dis Colon Rectum 42:1560–1568

    CAS  PubMed  Google Scholar 

  8. Hida J, Yasutomi M, Maruyama T, Yoshifuji T, Tokoro T, Wakano T, Uchida T, Ueda K (1999) Detection of a rectocele-like prolapse in the colonic J-pouch using pouchography: cause or effect of evacuation difficulties? Surg Today 29:1237–1242

    Article  CAS  PubMed  Google Scholar 

  9. Romanos 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

    CAS  PubMed  Google Scholar 

  10. Heald RJ, Ryall RDH (1986) Recurrence and survival after total meso-rectal excision for rectal cancer. Lancet 1:1479–1482

    Article  CAS  PubMed  Google Scholar 

  11. Ikeuchi H, Kusunoki M, Shoji Y, Yamamura T, Utsunomiya J (1997) Functional results after “High” coloanal anastomosis and “Low” coloanal anastomosis with a colonic J-pouch for rectal carcinoma. Surg Today 27:702–705

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  13. 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

    CAS  PubMed  Google Scholar 

  14. Ho YH, Tan M, Leong AFPK, Seow-Choen F (2000) Ambulatory manometry in patients with colonic J-pouch and straight coloanal anastomoses. Randomized, controlled trial. Dis Colon Rectum 43:793–799

    CAS  PubMed  Google Scholar 

  15. Hallböök O, Pählman 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

    Article  PubMed  Google Scholar 

  16. Enker WE, Stearns MW, Janov AJ (1985) Peranal coloanal anastomosis following low anterior resection for rectal carcinoma. Dis Colon Rectum 28:576–581

    CAS  PubMed  Google Scholar 

  17. Bernard D, Morgan S, Tasse D, Wassef R (1989) Preliminary results of coloanal anastomosis. Dis Colon Rectum 32:580–584

    CAS  PubMed  Google Scholar 

  18. Hallböök O, Johansson K, Sjödahl R (1996) Laser Doppler blood flow measurement in rectal resection for carcinoma—comparison between the straight and colonic J pouch reconstruction. Br J Surg 83:389–392

    PubMed  Google Scholar 

  19. Berger A, Tiret E, Parc R, Frileux P, Hannoun L, Nordlinger B, Ratelle R, Simon R (1992) Excision of the rectum with colonic J pouch-anal anastomosis for adenocarcinoma of the low and mid rectum. World J Surg 16:470–477

    CAS  PubMed  Google Scholar 

  20. Araki Y, Isomoto H, Tsuzi Y, Matsumoto A, Yasunaga M, Yamaguchi K, Hayashi K, Kodama T (1999) Functional results of colonic J-pouch anastomosis for rectal cancer. Surg Today 29:597–600

    Article  CAS  PubMed  Google Scholar 

  21. Hallböök O, Nystrom PO, Sjödahl R (1997) Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer. Dis Colon Rectum 40:332–338

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Department of Surgery, School of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Hiroyoshi Matsuoka, Tadahiko Masaki, Masanori Sugiyama & Yutaka Atomi

Authors
  1. Hiroyoshi Matsuoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tadahiko Masaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masanori Sugiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yutaka Atomi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroyoshi Matsuoka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Matsuoka, H., Masaki, T., Sugiyama, M. et al. Large contractions in the colonic J-pouch as a possible cause of incomplete evacuation. Langenbecks Arch Surg 389, 391–395 (2004). https://doi.org/10.1007/s00423-004-0499-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-004-0499-2

Keywords

Search

Navigation