Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates.
OBJECTIVE
To assess the efficacy of a novel coloplasty colonic pouch design in optimizing bowel function after ultralow anterior resection.


BACKGROUND
A colonic J-pouch may reduce excessive stool frequency and incontinence after anterior resection, but at the risk of evacuation problems. Experimental surgery on pigs has suggested that a coloplasty pouch (CP) may be a useful alternative. Although CP has recently been shown to be feasible in patients, there is no randomized controlled trial comparing bowel function with the J-pouch.


METHODS
After anterior resection for cancer, patients were allocated to either J-pouch or CP-anal anastomoses. Continence scoring, anorectal manometry, and endoanal ultrasound assessments were made before surgery. All complications were recorded, and these preoperative assessments were repeated at 4 months. The assessments were repeated again at 1 year, and a quality of life questionnaire was added.


RESULTS
Eighty-eight patients were recruited from October 1998 to April 2000. Both groups were well matched for age, gender, staging, adjuvant therapy, and mean follow-up. There were no differences in the intraoperative time and hospital stay. CP resulted in more anastomotic leaks. At 4 months, J-pouch patients had 10.3% less stool fragmentation but poorer stool deferment and more nocturnal leakage. However, there were no differences in the bowel function, continence score, and quality of life at 1 year. There were no differences in the anorectal manometry and endoanal ultrasound findings.


CONCLUSIONS
Coloplasty pouches resulted in more anastomotic leaks and minimal differences in bowel function. At present, the J-pouch remains the benchmark for routine clinical practice, and due care (including defunctioning stoma) should be exercised in situations requiring CP.
Ho
Yik-Hong
YH
Department of Colorectal Surgery, Singapore General Hospital, Singapore. yik-hong.ho@bigpond.com
Brown
Steven
S
Heah
Siu-Meng
SM
Tsang
Charles
C
Seow-Choen
Francis
F
Eu
Kong-Weng
KW
Tang
Choong Leong
CL
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003131:Combined Modality Therapy; D005242:Fecal Incontinence; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods*; D011788:Quality of Life; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology; D016896:Treatment Outcome; D014463:Ultrasonography