Safety and morbidity after ultra-low coloanal anastomoses: J-pouch vs end-to-end reconstruction.
OBJECTIVE
Anastomotic failure after ultra-low anterior rectum resection is the most important complication, and it is influenced by the type of reconstruction. The aim of this study was to compare retrospectively the straight coloanal anastomosis with the J-pouch reconstruction concerning the development of anastomotic leakage.


METHODS
Fifty-six of 381 consecutive patients underwent low anterior rectum resection with total mesorectal excision and ultra-low coloanal anastomosis at 3-4 cm from the anocutan line. A 5-cm J-pouch (side-to-end) was performed in 25, a straight coloanal anastomosis in 25, and a coloplasty in 6 patients, respectively.


RESULTS
No influence by age, body mass index, and operating time on anastomotic leakage rate was found. Leakage was found in eight patients with straight coloanal anastomosis, resulting in a leakage rate of 32% compared to one patient in the J-pouch group (P = 0.023).


CONCLUSIONS
Patient's safety is higher after J-pouch reconstruction because of the lower anastomotic failure rate, and functional results had been reported as similar after J-pouch reconstruction and straight coloanal anastomosis. Therefore, we clearly argue for a J-pouch reconstruction as the standard method after ultra-low coloanal anastomosis.
Steffen
Thomas
T
Department of Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland. thomas.steffen@kssg.ch
Tarantino
Ignazio
I
Hetzer
Franc Heinrich
FH
Warschkow
René
R
Lange
Jochen
J
Zünd
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000517:prevention & control; D013536:Suture Techniques; D016896:Treatment Outcome