The colon J-pouch as a cause of evacuation disorders after rectal resection: myth or fact?
BACKGROUND
Colon J-pouch (JCP) reconstructions result in a better functional outcome than straight coloanal anastomosis (SCA) in terms of continence and frequency of defecation after rectal resection but might be associated with more evacuation difficulties. In order to evaluate this hypothesis, we systematically reviewed the literature to collect data on evacuation disorders after rectal resection in randomized or otherwise comparative trials.


METHODS
Randomized controlled trials and comparative trials evaluating CJP versus SCA, latero-terminal anastomosis (LTA), and transverse coloplasty pouch (TCP) were ascertained by methodical search using Medline, Embase, and PubMed. Pooled estimates of outcomes were calculated for early-, intermediate-, and long-term follow-up. Primary meta-analysis outcomes were sensation of incomplete evacuation, prolonged evacuation, use of laxatives, use of enemas and suppositories, and stool fragmentation.


RESULTS
When compared to SCA, CJP was associated with significantly less "prolongation of evacuation" but more "use of laxatives" in the intermediate-term follow-up, while both less "sensation of incomplete evacuation" and less "fragmentation" was found after CJP in the long-term. When compared to TCP, CJP was associated with significantly less fragmentation in the intermediate-term follow-up.


CONCLUSIONS
Evacuation disorders are a unique problem of low anterior resection and are not specifically related to the colon J-pouch.
Rink
Andreas D
AD
Department of Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany. andreas.rink@ukmainz.de
Sgourakis
George
G
Sotiropoulos
Georgios C
GC
Lang
Hauke
H
Vestweber
Karl-Heinz
KH
D039021:Colonic Pouches / Q000009:adverse effects*; D003672:Defecation; D011183:Postoperative Complications / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D012002:Rectal Diseases / Q000209:etiology*; D012004:Rectal Neoplasms / Q000601:surgery*