Abstract
Introduction. Patients with the diagnosis of carcinoma rectum after random allocation were assigned to 2 groups. One group was subjected to total mesorectal excision with coloplasty neorectum reconstruction and another group to total mesorectal excision with straight anastomosis. This randomization was done by odds and even method by the sister in charge of the ward to avoid bias in randomization. The study included 42 patients with diagnosis of carcinoma rectum from 4 to 12 centimeters from anal verge. Composite incontinence score, bladder function, and sexual function were considered as the main outcome measures. Results. All patients of transverse coloplasty group had mild or moderate composite incontinence score while 7 (36.8%) patients of straight anastomosis group had a severe score at 7th POD (P < 0.05). At 6 months, 100% patients in transverse coloplasty group had a nil score which was not achieved by any of the patients in the other group. An intragroup comparison showed an improvement in score with time in both groups more marked in transverse coloplasty group. Conclusion. Transverse coloplasty group showed a better QOL so far as anal incontinence is considered. However, no statistically significant difference was achieved when comparing bladder and sexual dysfunction between the two groups.
Highlights
Patients with the diagnosis of carcinoma rectum after random allocation were assigned to 2 groups
One patient in transverse coloplasty pouch (TCP) group died of postoperative sepsis and one patient in straight coloanal anastomosis (SA) group died of pulmonary thromboembolism
The modern day surgical treatment of rectal cancer started with abdominoperineal resection (APR) described by Czerny in 1884
Summary
A better understanding of oncological factors governing tumor spread in rectal cancer, the advent of total mesorectal excision (TME) with nerve sparing, use of neoadjuvant chemoradiation, and the development of stapling devices have made it possible to avoid a permanent stoma in most of the patients undergoing surgery for low rectal carcinomas. Performing a straight coloanal anastomosis for restoring the bowel continuity may be complicated by “anterior resection syndrome (ARS)” characterized by increase in defecatory frequency, urgency, and incontinence [1, 2]. Construction of a J-pouch can be technically difficult in a narrow male pelvis and in patients with a thick or short mesocolon [16] To overcome these problems, a very small pouch, the transverse coloplasty pouch (TCP), was conceptualized by Z’graggen K and his colleagues and initially tested for its safety and early outcome in an animal model where it was compared with the standard operations like straight coloanal anastomosis and colon J-pouch [17, 18]. We undertook this study to compare the functional outcome and impact on overall quality of life in patients subjected to a straight coloanal anastomosis with those subjected to a transverse coloplasty pouch neorectum reconstruction
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