A meta-analysis comparing functional outcome following straight coloanal anastomosis versus a colonic J pouch

Abstract

Abstract A meta-analysis of all randomized controlled trials comparing straight coloanal anastomosis to colonic J pouch anal anastomosis following rectal resection for low rectal cancer was performed. Five trials met the inclusion criteria. Overall, there were 141 patients randomized to straight coloanal anastomosis and 133 to colonic J pouch. There were no significant differences in the wound infection rate (OR 1.1; 95% CI 0.36-3.31), anastomotic leak rate (OR 1.2; 95% CI 0.39-3.72), or postoperative mortality (OR 7.99; 95% CI 0.5-128.3). Functional results were significantly better at 1-year follow-up in patients with a colonic J pouch. Thus, a smaller proportion of patients with a colonic J pouch had more than 3 bowel movements/day (OR 0.17; 95% CI 0.08-0.40), experienced urgency (OR 0.13; 95% CI 0.07-0.23), had nighttime soiling (OR 0.27; 95% CI 0.11-0.70), or used antidiarrheal medication (OR 0.26; 95% CI 0.11-0.59). These data suggest that the addition of a colonic J pouch leads to improved early functional results in patients having a sphincter-saving procedure for low rectal cancer. However, the overall quality of the trials was poor, so the results must be interpreted cautiously and more trials may be warranted. Copyright © 2002 by W.B. Saunders Company