[Functional outcome after hand-sewn versus stapled colonic J pouch anastomosis for rectal carcinoma].
OBJECTIVE
The aim of this study was to compare the surgical and functional results of hand-sewn and stapled colonic J-pouch anastomoses after proctectomies for cancer.


METHODS
Over a 6-year period, 120 patients had a laparotomic conservative rectal excision with total mesorectal excision but without intersphincteric dissection, for cancer of the mid- and lower rectum: the colonic J-pouch anastomosis was hand-sewn for 49 and stapled for 71 patients. The functional results were assessed at 1 year, by a questionnaire completed by the patient.


RESULTS
Morbidity was 37% in the hand-sewn group and 38% in the stapled group (ns). Mean duration of surgery in the hand-sewn group was 288 minutes and in the stapled group, 246 minutes (p<0.001). At 1 year, the rate of perfect continence was 71% for the hand-sewn group and 76% for the stapled group (ns). Significantly, more patient from the hand-sewn groups used enemas (16% versus 3%, p<0.005). On the other hand, there was no significant difference between the two groups for wearing protection, urgency, number of stools a day or gas/stool discrimination.


CONCLUSIONS
There is no major difference in either the surgical or functional results between hand-sewn or stapled colonic J-pouch anastomosis by laparotomy for rectal cancer. Because it is simpler and faster to perform, a stapled pouch is preferable when the tumor site so permits.
Hennequin
S
S
Service de chirurgie digestive et oncologique, hôpital Ambroise-Paré, AP-HP, Boulogne, France.
Benoist
S
S
Penna
C
C
Prot
T
T
Nordlinger
B
B
D000714:Anastomosis, Surgical / Q000379:methods*; D039021:Colonic Pouches; D004733:Enema / Q000706:statistics & numerical data; D005242:Fecal Incontinence / Q000145:classification; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013537:Sutures; D016896:Treatment Outcome