Preservation of rectal function after low anterior resection with formation of a neorectum.
Recent advances in surgery have enabled low rectal cancers to be resected, while at the same time restoring bowel continuity and preserving the anal sphincter. Although a permanent stoma is avoided and the operation is oncologically sound, function may be compromised. Many patients with a straight coloanal anstomosis suffer from urgency, incontinence, and bowel frequency-the so-called anterior resection syndrome. Over the last 15 years, surgical developments have aimed at improving function after restoration of bowel continuity, essentially by creating a neorectum. The best known and most widely practiced operation involves formation of a colonic J-pouch. The physiological and functional outcomes of the colonic J-pouch are discussed, along with controversies surrounding construction. Although a J-pouch improves some aspects of function, the results are not perfect. Alternatives to the colonic J-pouch are appraised, indicating future areas of development.
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
S R
SR
Brown
F
F
Seow-Choen
D000714:Anastomosis, Surgical / Q000009:adverse effects; D006801:Humans; D016737:Proctocolectomy, Restorative; D012004:Rectal Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology* / Q000601:surgery*; D013577:Syndrome