Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection.
OBJECTIVE
The authors compared clinical bowel function and complications of a low anterior resection with either a straight or colonic J pouch anastomosis.


BACKGROUND
Urgency and frequent bowel movements after rectal resection with a low anastomosis have been related to the loss of rectal reservoir function. Reconstruction with a colonic J pouch possibly can obviate some of this dysfunction. Earlier reports have been favorable, but they must be verified in randomized trials.


METHODS
One hundred patients with rectal cancer in whom a sphincter-saving procedure was appropriate were randomized to reconstruction with either a straight or a colonic J pouch anastomosis.


RESULTS
The incidence of symptomatic anastomotic leakage was lower in the pouch group (2% vs. 15%, p = 0.03). Eighty-nine patients could be evaluated after 1 year. The pouch patients had significantly fewer bowel movements per 24 hours, and less nocturnal evacuations, urgency, and incontinence. Overall well-being owing to the bowel function was rated significantly higher by the pouch patients.


CONCLUSIONS
Reconstruction with a colonic J pouch was associated with a lower incidence of anastomotic leakage and better clinical bowel function when compared with the traditional straight anastomosis. Functional superiority was especially evident during the first 2 months.
Hallböök
O
O
Department of Surgery, University Hospital, Linköping, Sweden.
Påhlman
L
L
Krog
M
M
Wexner
S D
SD
Sjödahl
R
R
D000230:Adenocarcinoma / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods / Q000706:statistics & numerical data; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016737:Proctocolectomy, Restorative / Q000379:methods* / Q000706:statistics & numerical data; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000601:surgery; D013548:Sweden