Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis.
BACKGROUND
Functional outcome after rectal excision with coloanal anastomosis is improved by construction of a colonic J pouch. Present prospective randomized studies lack follow-up beyond 1 year. The aim of this study was to assess the clinical outcome at both short- and long-term follow-up.


METHODS
Forty patients with low rectal cancer were randomized prospectively to either J colonic pouch-anal anastomosis or a straight coloanal anastomosis. Clinical assessments were performed 3, 12 and 24 months after colostomy closure using a standard questionnaire and physical examination.


RESULTS
There was no significant difference in the complication rate between the two groups. There was a significant (P < 0.01) improvement in frequency of defaecation at 3, 12 and 24 months for patients with a reservoir. Similarly, fragmentation (clustering of stools) was significantly less at 3 and 12 months (P < 0.01) in the reservoir group, and incontinence occurred less frequently in the first year (P = 0.09). By 24 months no patient in either group suffered from major or minor incontinence.


CONCLUSIONS
The functional improvement gained from a colonic reservoir in coloanal anastomosis continues to benefit the patient for at least 2 years.
Lazorthes
F
F
Department of General and Digestive Surgery, Purpan Hospital, Toulouse, France.
Chiotasso
P
P
Gamagami
R A
RA
Istvan
G
G
Chevreau
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome