[Colon pouch as neorectum. Technique, indications and results].
Colon pouch as neorectum. Technique, indications and results.The possibilities to preserve the intestinal continuity after surgery for rectal cancer have remarkably improved. After straight coloanal anastomosis the problem of a high stool frequency together with urgency was frequently to observe. The introduction of the colonic J-Pouch improved the functional outcome of rectal cancer-surgery very much. In a review of the literature the stool-frequency after one year was 0.5-4 bowel movements per day compared to 0.5-10 per day after straight coloanal anastomosis. Urgency was as well reduced. The parameter of urgency can be best expressed by measuring the urgency volume in balloon-volumetry. Here the volume for J-Pouch was 75 ml compared to 50 ml in straight coloanal anastomosis. At the beginning of colonic J-pouch-surgery evacuation disorders were more frequent observable. Clinical and experimental studies could demonstrate that a big pouch-size caused this problem. Since a pouch-length of 6 cm is used evacuation disorders are very rare. The improved perfusion of the side-to-end anastomosis in pouch-anastomosis reduces the rate of anastomotic leakage's (pouch 1.9 % vs. coloanal anastomosis 15.2 %). In published retrospective studies the oncological outcome is completely comparable to straight coloanal anastomosis. In the case of technical impossibility of J-pouch formation the ileocecal interponant is a possible alternative. This procedure has the same functional outcome.
Kroesen
A J
AJ
Chirurgische Klinik I: Viszeral, Gefäss und Thoraxchirurgie, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Germany.
Buhr
H J
HJ
D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D003672:Defecation; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors