Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized controlled trial.
The colonic J-pouch (pouch group) functions better than the straight coloanal anastomosis (straight group) immediately after ultra-low anterior resection, but there are few studies with long-term follow-up. This randomized controlled study compared functional outcome, anal manometry, and rectal barostat assessment of these two groups over a 2-year period. Forty-two consecutive patients were recruited, of which 19 of the straight group [17 men with a mean age of 62.1 +/- 2.3 (SEM) year] and 16 of the pouch group (11 men with a mean age of 61.3 +/- 3.2 year) completed the study. Four died from metastases and two emigrated; there was no surgical morbidity or local recurrence. At 6 months the Pouch patients had significantly less frequent stools (32.9 +/- 2.8 vs. 49 +/- 1.4/week; p < 0.05) and less soiling at passing flatus (38% vs. 73.7%; p < 0.05). At 2 years both groups had improved with no longer any differences in stool frequency (7.3 +/- 0.4 vs. 8 +/- 0.2/week) and soiling at passing flatus (38% vs. 53%). Defecation problems remained minimal in both groups. Anal squeeze pressures were significantly impaired in both groups up to 2 years (p < 0.05). The rectal maximum tolerable volume and compliance were not different between groups. Rectal sensory testing on the barostat phasic program showed impairment at 6 months and recovery at 2 years, suggesting that postoperative recovery of residual afferent sympathetic nerves may play a role in functional recovery. In conclusion, stool frequency and incontinence were less in the Pouch patients at 6 months; but after adaptation at 2 years the straight group patients yielded similar results. Nonetheless, this functional advantage can be given to patients with minimal added effort or complications by using the colonic J-pouch.
Ho
Y H
YH
Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore City 169806, Singapore. hoyh@sgh.gov.sg
Seow-Choen
F
F
Tan
M
M
D000230:Adenocarcinoma / Q000503:physiopathology* / Q000601:surgery*; D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D015331:Cohort Studies; D003106:Colon / Q000503:physiopathology* / Q000601:surgery*; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007422:Intestines / Q000503:physiopathology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome