title: Horizontal inclination of the longitudinal axis of the colonic J-pouch: defining causes of evacuation difficulty.
abstract: OBJECTIVE
  Functional outcome after low anterior resection for rectal cancer is improved by the construction of a colonic J-pouch. One disadvantage of this type of reconstruction is evacuation difficulty, which has been associated with large pouches. The purpose of this study was to elucidate the causes of evacuation difficulty in large pouches using pouchography.
  
  
  METHODS
  The angle between the longitudinal axis of the pouch and the horizontal line (pouch-horizontal angle) on lateral pouchography was determined in 26 patients with 10-cm J-pouch reconstructions (10-J group) and 27 patients with 5-cm J-pouch reconstructions (5-J group). Measurement were made at three months, one year, and two years after surgery. Clinical function was evaluated using a questionnaire one year postoperatively.
  
  
  RESULTS
  The pouch-horizontal angle in the 10-J group was significantly smaller than that in the 5-J group at all three time points. In both groups the pouch-horizontal angle at one year was significantly smaller than that at three months. There were no significant differences between the pouch-horizontal angles at one and two years. An evacuation difficulty was significantly more common in the 10-J group than the 5-J group.
  
  
  CONCLUSIONS
  The evacuation difficulty observed in patients with large colonic J-pouch reconstructions may be attributed to the development of a horizontal inclination within one year of surgery.
authors.affiliation: First Department of Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Hida
authors.forename: M
authors.initials: M
authors.lastname: Yasutomi
authors.forename: T
authors.initials: T
authors.lastname: Maruyama
authors.forename: T
authors.initials: T
authors.lastname: Tokoro
authors.forename: T
authors.initials: T
authors.lastname: Uchida
authors.forename: T
authors.initials: T
authors.lastname: Wakano
authors.forename: R
authors.initials: R
authors.lastname: Kubo
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001466:Barium Sulfate; D016009:Chi-Square Distribution; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D003672:Defecation / Q000502:physiology*; D003974:Diatrizoate Meglumine; D004733:Enema; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D012004:Rectal Neoplasms / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate; D003974:Diatrizoate Meglumine