Transverse coloplasty pouch. A novel neorectal reservoir.
BACKGROUND
The functional results after complete rectal excision can be improved by a neorectal reservoir. We recently developed a new technique for the formation of a small colon pouch, which we named the transverse coloplasty pouch. The technique demonstrated favorable functional results in an animal model. We report the first description of the human 'transverse coloplasty pouch' according to our early clinical experience.


METHODS
The technical steps in the formation of the transverse coloplasty pouch are described in detail, illustrated and discussed. After completion of the total mesorectal excision, a purse-string suture is fitted to the distal opening of the mobilized colon. The anvil of a circular stapler is secured by tying the purse-string suture. The colon is opened longitudinally, starting 2 cm proximal to the rim of the anvil. Depending upon the size of the colon, the incision measures 7-9 cm. In analogy to a pyloroplasty, the transverse coloplasty pouch is formed by lateral traction and the transverse opening is closed by running sutures. The continence-preserving neorectal reconstruction is completed by either a stapled anastomosis or a handsewn end-to-end pouch-anal anastomosis.


CONCLUSIONS
The advantages of the transverse coloplasty pouch are the simplicity of the technique and the facilitated tension-free anastomosis of the neorectum to the dentate line. This is a particular advantage in obese patients with a thick mesocolon and in individuals with a narrow muscular pelvis and/or a short mesocolon.
Z'graggen
K
K
Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Bern, Switzerland.
Maurer
C A
CA
Büchler
M W
MW
D006801:Humans; D011182:Postoperative Care; D011300:Preoperative Care; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*