title: Detection of a rectocele-like prolapse in the colonic J-pouch using pouchography: cause or effect of evacuation difficulties?
abstract: The functional outcome after a low anterior resection for rectal cancer is improved by a colonic J-pouch reconstruction. One functional problem with J-pouches is difficulty in evacuation, which is more common with large reconstructions. Since rectoceles are common findings on defecography in patients with evacuation difficulties, we proposed that a rectocele-like prolapse may be thus found in patients with large J-pouches. Pouchography was used to identify a rectocele-like prolapse (RP) in 26 patients with a 10-cm J-pouch (10-J group) and 27 patients with a 5-cm J-pouch (5-J group). Pouchography was performed at 3 months, 1 year, and 2 years after surgery. Functional assessments were performed 1 year postoperatively. Clinical function was evaluated using a questionnaire. The evacuation function was evaluated by the balloon expulsion and saline evacuation test. No patients had an RP at 3 months or 1 year after surgery. An RP was significantly more common in the 10-J group than in the 5-J group at 2 years after surgery (P = 0.0374). An evacuation difficulty was significantly more common in the 10-J group than in the 5-J group. The evacuation function in the 10-J group was also significantly inferior to that in the 5-J group. An RP appearing 2 years after surgery is more common in patients with evacuation difficulties and large colonic J-pouch reconstructions.
authors.affiliation: First Department of Surgery, Kinki University School of Medicine, 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: Yoshifuji
authors.forename: T
authors.initials: T
authors.lastname: Tokoro
authors.forename: T
authors.initials: T
authors.lastname: Wakano
authors.forename: T
authors.initials: T
authors.lastname: Uchida
authors.forename: K
authors.initials: K
authors.lastname: Ueda
mesh_terms: D000368:Aged; D003672:Defecation; D019841:Defecography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000601:surgery*; D012005:Rectal Prolapse / Q000000981:diagnostic imaging* / Q000209:etiology