Pouch reconstruction after resection of the rectum

Abstract

Pouch reconstruction after resection of the rectum. 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 faecal incontinence, urge, frequency and fragmentation. To investigate the potential functional benefit of a coloanal pouch reconstruction we conducted a prospective study. Some 55 patients [29 men; median age 66,4 (30-85)] underwent low anterior resection of the rectum followed by coloanal J-pouch reconstruction. Pouch size was 5-7 cm, a temporary stoma was fashioned in 32 patients. Indications for the operation were: 1. rectal cancer: n = 51, 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 two patients required reoperation. A pelvic abscess was encountered in three patients as well as one pelvic haematoma. Micturition was impaired in five patients. To date 47 patients have completed 12 months follow-up after reversal of the ileostomy. Patients were seen at three-monthly intervals. Mean stool frequency/day was 3.9 after 3 and 2.6 after 12 months. After 3 months 38 patients (69 %) reported complete continence which increased to 83 % at 1 year. 18 Patients (33 %) complained of urge defaecation initially, which decreased to 14.5 % after 1 year. Fragmentation was observed in 40 % at 3 and and 22 % at 12 months, respectively. In conclusion, our initial experience with colonic J-pouch reconstruction shows good functional results.