Functional Results in Patients with Coloanal Pouch after Low Anterior Resection of the Rectum

Abstract

Functional results after low anterior resection of the rectum and straight end-to-end coloanal anastomosis are often poor. Patients are frequently troubled by the so called „anterior resection syndrome“ which comprises fecal incontinence, urge, frequency and fragmentation.To investigate the potential functional benefit of a coloanal pouch reconstruction we conducted a prospective study. Some 42 patients (23 men; median age 65 years [30 to 85]) underwent low anterior resection of the rectum followed by coloanal J-pouch reconstruction. Pouch size was 5 to 7 cm, a temporary stoma was fashioned in 32 patients. Indications for the operation were: 1. rectal cancer n = 38,2. recurrent adenoma n = 2, 3. recto-vaginal fistula n = 1 and 4. severe non-specific proctitis n = 1. We observed 5 anastomotic leakages of which 2 patients required reoperation. A pelvic abscess was encountered in 3 patients as well as 1 pelvic hematoma. Micturition was impaired in 4 patients. To date 35 patients have completed 12 months follow-up after reversal of the ileostomy. Patients were seen at 3-monthly intervals. Mean stool frequency/day was 3.9 after 3 and 2.2 after 12 months. After 3 months 24 patients (69%) reported complete continence which increased to 86% at 1 year. Nine patients (26%) complained of urge defecation initially, which decreased to 9% after 1 year. Fragmentation was observed in 40% and 20% at 3 and 12 months, respectively. In conclusion, our initial experience with colonic J-pouch reconstruction shows good functional results.