Abstract
PURPOSE: Bowel function after ultralow anterior resection may be improved by a colonic J-pouch. The aim of this study was to compare the bowel function and ambulatory manometry in patients randomly assigned to straight coloanal anastomosis or colonic J-pouch. METHODS: Forty-seven consecutive patients underwent ultralow anterior resection for adenocarcinoma. The colonic J-pouch was constructed with 6-cm limbs. A bowel function questionnaire was administered at one year after surgery. Ambulatory manometry was performed before and at one year after surgery. RESULTS: Values are expressed below as mean and (standard error of the mean). Patients with colonic J-pouch were found to have less frequent stools (4.6 (0.3)vs. 7.1 (0.9) stools/day;P<0.05) and stool clustering (35vs. 63.2 percent;P<0.05) and were less unlikely to soil when passing flatus (85vs. 35.3 percent;P<0.05). The ambulatory anorectal pressure gradient was better preserved in the colonic J-pouch group (30.3 (3.7)vs. 18 (2.6) mmHg;P<0.05). Stool frequency was predicted by the mean rectal pressures (t=3.368;P=0.003). However, higher mean rectal pressures were tolerated by the colonic J-pouch for each daily bowel movement (6.7 (0.6)vs. 4.4 (0.5) mmHg/stool;P=0.008). Anal sampling episodes and slow wave activity were impaired postoperatively in both groups. The minimal anal pressures were lower in patients unable pass flatus without soiling (12.4 (5.3)vs. 26 (2.3) mmHg;P=0.004). Large contraction waves were not seen, and this may be related to the absence of severe defecation problems with 6-cm colonic J-pouches. CONCLUSIONS: A colonic J-pouch resulted in better bowel function and more favorable ambulatory manometric findings at one year of follow-up.
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Williamson ME, Lewis WG, Holdsworth PJ, Finan PJ, Johnston D. Decrease in the anorectal pressure gradient after low anterior resection of the rectum: a study using continuous ambulatory manometry. Dis Colon Rectum 1994;37:1228–31.
Farouk R, Duthie GS, Lee PW, Monson JR. Endosonographic evidence of injury to the internal anal sphincter after low anterior resection: long-term follow-up. Dis Colon Rectum 1998;41:888–91.
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.
Joo JS, Latulippe JF, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of colonic J-pouch sustained? Dis Colon Rectum 1998;41:740–6.
Lazorthes F, Chiotasso P, Gamagami 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.
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.
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.
Ortiz H, De Miguel M, Armendáriz P, Rodriquez J, Chocarro C. Coloanal anastomosis: are functional results better with a pouch? Dis Colon Rectum 1995;38:375–7.
Chew SB, Tindal DS. Colonic J-pouch as a neorectum: functional assessment. Aust N Z J Surg 1997;67:607–10.
Seow-Choen F, Goh H-S. Prospective randomized trial compared J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 1995;82:608–10.
Dehni N, Tiret E, Singland JD,et al. Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch-anal anastomosis. Dis Colon Rectum 1998;41:817–23.
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.
Ikeuchi H, Kusunoki M, Shoji Y, Yamamura T, Utsunomiya J. Functional results after “high” coloanal anastomosis and “low” coloanal anastomosis with colonic J-pouch for rectal carcinoma. Surg Today 1997;27:702–5.
Wang JY, You YT, Chen HH, Chiang JM, Yeh CY, Tang R. Stapled colonic J-pouch-anal anastomosis without a diverting colostomy for rectal carcinoma. Dis Colon Rectum 1997;40:30–4.
Miller R, Lewis GT, Bartolo DC, Cervero F, Mortensen NJ. Sensory discrimination and dynamic activity in the anorectum: evidence using a new ambulatory technique. Br J Surg 1988;75:1003–7.
Miller R, Bartolo DC, Roe AM, Mortensen NJ. Assessment of microtransducers in anorectal manometry. Br J Surg 1988;75:40–3.
Romanos 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;83:1774–6.
Griffen FD, Knight CD Sr, Knight CD Jr. Results of the double stapling procedure in pelvic surgery. World J Surg 1992;16:866–71.
McDonald PJ, Heald RJ. A survey of postoperative function after rectal anastomosis with circular stapling devices. Br J Surg 1983;70:727–9.
Ho Y-H, Tan M. Ambulatory anorectal manometric findings in patients before and after haemorrhoidectomy. Int J Colorectal Dis 1997;12:296–7.
Lazorthes F, Gamagami 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.
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.
Dehni N, Schlegel RD, Cunningham C, Guiguet M, Tiret E, Parc R. Influence of a defunctioning stoma on leak rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg 1998;85:1114–7.
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Ho, YH., Tan, M., Leong, A.F.P.K. et al. Ambulatory manometry in patients with colonic J-pouch and straight coloanal anastomoses. Dis Colon Rectum 43, 793–799 (2000). https://doi.org/10.1007/BF02238016
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DOI: https://doi.org/10.1007/BF02238016