title: Modified anoabdominal rectal resection and colonic J-pouch anal anastomosis for lower rectal carcinoma: preliminary report.
abstract: BACKGROUND
  There has recently been increasing interest in coloanal reconstruction after proctectomy for low rectal carcinoma. We describe here our pilot experience with seven patients undergoing modified anoabdominal resection of the rectum and a colonic J-pouch anal anastomosis.
  
  
  METHODS
  The procedure varied according to the extent of internal anal sphincter (IAS) resection (type a, partial resection of the upper IAS; type b, circumferential resection of the upper IAS; type c, partial preservation of the lower IAS; and type d, total resection of the IAS).
  
  
  RESULTS
  None of the patients had incontinence, but preservation of the lower half of the IAS (types a and b) showed functional superiority over more extensive IAS resection (types c and d). Only patients who underwent types c and d resection needed medications to reduce stool frequency.
  
  
  CONCLUSIONS
  Our results suggest that the lower half of the IAS has a more important role than the upper half in the control of defecation. Total resection of the IAS did not sacrifice continence, but preservation of at least the lower IAS resulted in a better quality of life. Careful patient selection is needed when considering the use of these procedures for tumors in the lowest part of the rectum.
authors.affiliation: Second Department of Surgery, Hyogo College of Medicine, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kusunoki
authors.forename: Y
authors.initials: Y
authors.lastname: Shoji
authors.forename: H
authors.initials: H
authors.lastname: Yanagi
authors.forename: S
authors.initials: S
authors.lastname: Fujita
authors.forename: T
authors.initials: T
authors.lastname: Hatada
authors.forename: Y
authors.initials: Y
authors.lastname: Sakanoue
authors.forename: T
authors.initials: T
authors.lastname: Yamamura
authors.forename: J
authors.initials: J
authors.lastname: Utsunomiya
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D003672:Defecation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010865:Pilot Projects; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*