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Functional and Physiologic Assessment of the Colonic Reservoir or Side-to-End Anastomosis After Low Anterior Resection for Rectal Cancer: A Two-Year Follow-Up

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Diseases of the Colon & Rectum

PURPOSE

Functional disturbances are common after anterior resection for rectal cancer. This study was designed to compare functional and physiologic outcome after low anterior resection and total mesorectal excision with a colonic J-pouch or a side-to-end anastomosis.

METHODS

Functional and physiologic variables were analyzed in patients randomized to a J-pouch (n = 36) or side-to-end anastomosis (n = 35). Postoperative functional outcome was investigated with questionnaires. Anorectal manometry was performed preoperatively and at six months, one year, and two years postoperatively.

RESULTS

There was no statistical difference in functional outcome between groups at two years. Maximum neorectal volume increased in both groups but was approximately 40 percent greater at two years in pouches compared with the side-to-end anastomosis. Anal sphincter pressures volumes were halved postoperatively and did not recover during follow-up of two years. Male gender, low anastomotic level, pelvic sepsis, and the postoperative decrease of sphincter pressures were independent factors for more incontinence symptoms.

CONCLUSIONS

Colonic J-pouch and side-to-end anastomosis gives comparable functional results two years after low anterior resection. Neorectal volume had no detectable influence on function. There was a pronounced and sustained postoperative decrease in sphincter pressures.

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ACKNOWLEDGMENTS

The authors thank specialist nurses Gunilla Sundin and Annica Wistedt for performing and coordinating the anorectal physiology investigations.

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Authors and Affiliations

  1. Centre of Gastrointestinal Disease, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden

    Mikael Machado M.D., Ph.D., Jonas Nygren M.D., Ph.D., Sven Goldman M.D., Ph.D., F.R.C.S. & Olle Ljungqvist M.D., Ph.D.

  2. Centre for Surgical Sciences, Karolinska University Hospital, Huddinge, Stockholm, Sweden

    Mikael Machado M.D., Ph.D., Jonas Nygren M.D., Ph.D., Sven Goldman M.D., Ph.D., F.R.C.S. & Olle Ljungqvist M.D., Ph.D.

Authors
  1. Mikael Machado M.D., Ph.D.
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  2. Jonas Nygren M.D., Ph.D.
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  3. Sven Goldman M.D., Ph.D., F.R.C.S.
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  4. Olle Ljungqvist M.D., Ph.D.
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Corresponding author

Correspondence to Mikael Machado M.D., Ph.D..

Additional information

Supported by the Stockholm County Council, Public Health and Medical Services Committee and the Swedish Research Council, grant #09101.

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Machado, M., Nygren, J., Goldman, S. et al. Functional and Physiologic Assessment of the Colonic Reservoir or Side-to-End Anastomosis After Low Anterior Resection for Rectal Cancer: A Two-Year Follow-Up. Dis Colon Rectum 48, 29–36 (2005). https://doi.org/10.1007/s10350-004-0772-z

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