Colonic J-pouch anal anastomosis after ultralow anterior resection with upper sphincter excision for low-lying rectal cancer.

Abstract

AIM:

There is some evidence of functional superiority of colonic J-pouch over straight coloanal anastomosis (CAA) in ultralow anterior resection (ULAR) or intersphincteric resection. On the assumption that colonic J-pouch anal anastomosis is superior to straight CAA in ULAR with upper sphincter excision (USE: excision of the upper part of the internal sphincter) for low-lying rectal cancer, we compare functional outcome of colonic J-pouch vs the straight CAA.

METHODS:

Fifty patients of one hundred and thirty-three rectal cancer patients in whom lower margin of the tumors were located between 3 and 5 cm from the anal verge received ULAR including USE from September 1998 to January 2002. Patients were randomized for reconstruction using either a straight (n = 26) or a colonic J-pouch anastomosis (n = 24) with a temporary diverting-loop ileostomy. All patients were followed-up prospectively by a standardized questionnaire (Fecal Incontinence Severity Index (FISI) scores and Fecal Incontinence Quality of Life (FIQL) scales).

RESULTS:

We found that, compared to straight anastomosis patients, the frequency of defecation was significantly lower in J-pouch anastomosis patients for 10 mo after ileostomy takedown. The FISI scores and FIQL scales were significantly better in J-pouch patients than in straight patients at both 3 and 12 mo after ileostomy takedown. Furthermore, we found that FISI scores highly correlated with FIQL scales.

CONCLUSION:

This study indicates that colonic J-pouch anal anastomosis decreases the severity of fecal incontinence and improves the quality of life for 10 mo after ileostomy takedown in patients undergoing ULAR with USE for low-lying rectal cancer.

• Authors: Jae-Gahb Park, Min-Ro Lee, Seok-Byung Lim, Chang-Won Hong, Sang-Nam Yoon, Sung-Bum Kang, Seung-Chul Heo, Seung-Yong Jeong, Kyu-Joo Park
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 11 Issue 17 Pg. 2570-3 (May 07 2005) ISSN: 1007-9327 [Print] United States
• PMID: 15849813 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Topics

• Adult
• Aged
• Anal Canal (surgery)
• Anastomosis, Surgical (methods)
• Colonic Pouches
• Fecal Incontinence (prevention & control)
• Female
• Humans
• Male
• Middle Aged
• Postoperative Complications (prevention & control)
• Rectal Neoplasms (surgery)
• Rectum (surgery)