Function of a colonic J pouch continues to improve with time.
BACKGROUND
J pouch-anal anastomosis is thought to give superior functional results to straight coloanal anastomosis after rectal resection. Follow-up studies have suggested that this improvement is not maintained and that evacuatory difficulties may increase.


METHODS
Some 119 consecutive patients had a coloanal anastomosis after resection for rectal carcinoma over 113 months, 62 with a J pouch and 57 with a straight coloanal anastomosis. Functional results were determined by patient questionnaire. The two groups were compared for the first and second 5-year intervals of study.


RESULTS
Patients who had a J pouch had significantly better median Kirwan continence scores for the duration of the study and 5-9 years after surgery: 1 versus 2 (P = 0.05) and 1 versus 2 (P < 0.01), respectively. Some 5-9 years after surgery the median number of nocturnal bowel movements was significantly lower in patients who had a J pouch than in those with a straight coloanal anastomosis (0 versus 1; P = 0.02). Similarly, significantly better results were seen with regard to evacuation difficulties and urgency of defaecation.


CONCLUSIONS
The function of the J pouch was superior to that of the straight coloanal anastomosis and appeared to improve with time.
Harris
G J
GJ
Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA. mrguyharris@aol.com
Lavery
I C
IC
Fazio
V W
VW
D000230:Adenocarcinoma / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003672:Defecation / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016737:Proctocolectomy, Restorative / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods; D016896:Treatment Outcome