Coloplasty Pouch Research Articles

Textbook anastomotic success in patients with low rectal cancer treated by intersphincteric resection: reappraising surgical, oncological, and functional outcomes.

Previous studies on successful anastomosis after intersphincteric resection (ISR) for low rectal cancer (LRC) primarily focused on anastomotic complications rather than functional outcomes. Here, we improved the anastomotic success criteria by considering surgical, oncological, and functional outcomes and proposed a new composite outcome, "textbook anastomotic success" (TASS). This retrospective single-center study included patients with LRC treated with ISR from January 2014 to April 2020. TASS was defined as (1) no anastomotic complications occurring after ISR; (2) ileostomy was closed and there was no severe intestinal dysfunction 2years after ISR; and (3) no local recurrence within 2years of surgery. TASS was achieved upon meeting all indicators. We analyzed 259 patients with LRC, with 125 (48.3%) achieving TASS. Multivariate analysis showed that male sex (OR 0.47; 95% CI 0.27-0.81; p = 0.007), hypertension (OR 0.48; 95% CI 0.24-0.97; p = 0.041), ASA score ≥ 3 (OR 0.28; 95% CI 0.10-0.81; p = 0.018), pre-treatment major low anterior resection syndrome (OR 0.37; 95% CI 0.15-0.94; p = 0.037), and preoperative neoadjuvant chemoradiotherapy (OR 0.41; 95% CI 0.22-0.77; p = 0.006) were independent risk factors for not achieving TASS. Conversely, transverse coloplasty pouch (OR 2.13; 95% CI 1.07-4.25; p = 0.032) and higher anastomosis level (OR 1.56; 95% CI 1.05-2.30; p = 0.026) were independent protective factors for achieving TASS. The nomogram constructed to evaluate the probability of achieving TASS demonstrated good accuracy in the dataset (area under curve, 0.737). TASS provides a comprehensive quality assessment for ISR in patients with LRC. The nomogram predicting TASS may assist surgeons in decision-making for managing LRC.

Reconstructive techniques following low anterior resection for carcinoma of the rectum.

Multiple reconstructive techniques have been described for reconstruction after a low anterior resection for carcinoma rectum. Colonic J pouch (CJP), Side to end anastomosis (SEA), transverse coloplasty pouch (TCP) and Straight Colo-rectal/anal anastomosis were the most widely studied. PubMed, Embase and Cochrane data base were searched for randomized, non-randomized studies and systematic reviews from inception of the databases till July 31st, 2023. Considerable heterogeneity existed among different study findings. Reservoir techniques, including CJP, SEA, and TCP, exhibited reduced stool frequency, decreased urgency, and improved continence status compared to SCA, particularly in the short term. CJP maintained this advantage into the intermediate term. Other functional outcomes were similar among the techniques. However, these functional improvements did not translate into enhanced Quality of Life (QoL). TCP was associated with an elevated risk of anastomotic leaks. Other surgical outcomes remained comparable across all four techniques. Sexual outcomes also exhibited no significant variation. Some studies suggested that the size of the side limb in CJP or SEA may not significantly impact functional outcomes, implying that neorectum capacity may not be the primary determinant of improved function. The precise physiological mechanism underlying these findings remains unknown. In the short and intermediate terms, reservoir techniques demonstrated superior functional outcomes, but long-term performance was comparable among all techniques. Notably, enhanced functional outcomes did not translate to improved Quality of Life. TCP, while effective, is linked to an increased risk of anastomotic complications, necessitating cautious utilization.

Transverse Coloplasty Pouch versus Straight Coloanal Anastomosis Following Intersphincteric Resection for Low Rectal Cancer: the Functional Benefits May Emerge After Two Years

PurposeThis study aimed to compare the oncological and functional outcomes following intersphincteric resection (ISR) with transverse coloplasty pouch (TCP) or straight coloanal anastomosis (SCAA) for low rectal cancer. MethodsA single-center retrospective analysis was performed on patients with low rectal cancer who received ISR between January 2016 and June 2021. The primary endpoint was to compare the outcomes of bowel function within 1 year, 1 to 2 years, and 2 years after ileostomy closure in patients undergoing two different bowel reconstruction procedures (TCP or SCAA). The postoperative complications and oncological results were also compared between the two groups. ResultsA total of 235 patients were enrolled in this study (SCAA group: 166; TCP group: 69). There was no significant difference in complications, including grades A–C anastomotic leakage (9.6% vs 15.9%), 3-year local recurrence rates (6.1% vs 3.9%), disease-free survival (82.4%vs 83.8%), or overall survival (94.1% vs 94.7%) between the two groups. Two years after ileostomy closure, 52.7% of patients in the SCAA group were assessed as having major low anterior resection syndrome (LARS), which was significantly higher than the 25.9% of patients in the TCP group (P = 0.014), but no difference was found prior to 2 years. Similar differences were seen in Wexner scores 2 years after surgery (P = 0.032). Additionally, TCP was an independent protective factor for postoperative bowel function as measured by both the LARS (OR, 0.28; 95% CI, 0.10–0.82; p = 0.020) and Wexner scoring (OR, 0.28; 95% CI, 0.09–0.84; p = 0.023). ConclusionThis study suggests that TCP is a safe technique that may decrease bowel dysfunction after ISR for low rectal cancer compared with SCAA 2 years after ileostomy closure.

Magnetic resonance imaging in the diagnosis of necrosis of a pulled-through colon segment after abdomino-anal resection of the rectum for cancer

This study presents a case of necrosis of the pulled-through colon after abdomino-anal resection of the rectum, which was diagnosed by magnetic resonance imaging.
 A 47-year-old man underwent laparoscopically assisted abdomino-anal resection of the rectum with reconstruction of a coloplasty pouch and transverse colostomy in the course of combination treatment for locally advanced rectal cancer. The postoperative period was complicated by the development of an inflammatory response syndrome. On postoperative day 3, contrast-enhanced magnetic resonance imaging revealed swelling of the 15-cm segment of pulled-through colon up to the coloanal anastomosis with sharply attenuated contrast enhancement, whereas rectoscopy showed no changes. On postoperative day 6, a magnetic resonance imaging scan revealed a defect in the anterior wall of the coloplasty pouch with a parietal aerocele, and rectoscopy showed signs of necrosis of the bowel wall. On postoperative day 10, the magnetic resonance imaging scan presented no changes. Because of increasing signs of inflammation, relaparotomy with anastomosis disconnection and resection of the necrotized bowel segment were performed.
 Ischemia of the pulled-through colon after rectal surgery is a rare but serious complication. Our clinical case report demonstrates the potential of contrast-enhanced magnetic resonance imaging as a non-invasive method in case follow-up in patients with a complicated postoperative period for early diagnosis of ischemia and bowel wall defects, which helps to make the appropriate patient management plan.

Colonic pouch reconstruction after low anterior rectal resection

For many decades the coloanal anastomosis was traditionally created as an end-to-end anastomosis. Despite successful surgical restoration of the intestinal passage after low rectal resection and total mesorectal excision (TME), physiological continence and evacuation function cannot be achieved in many cases using end-to-end anastomosis. Subsequent complaints, such as fecal incontinence and urge problems, evacuation difficulties and high stool frequency (so-called low anterior resection syndrome, LARS) are the result. The combination of symptoms after TME known as LARS is described in the literature in up to 60% of cases. The increased occurrence of the imperative urge to defecate, frequent bowel movements and problems with fecal incontinence motivated surgeons to look for alternative anastomosis techniques. Side-to-end anastomosis, coloplasty pouch and colonic J‑pouch have been shown in various studies to be superior to end-to-end anastomosis in terms of functional results. Current studies could show that the side-to-end anastomosis (even if this is not apouch in the actual sense) and the two pouch techniques show comparable results in terms of functional outcome and the rate of anastomotic leakage. The alternative to coloanal anastomosis after TME is the abdominoperineal resection. Most, especially younger patients, prefer to try to maintain continence with the risk of the described functional problems. If the patients are well selected, TME can be carried out with the current techniques in such away that continuity is maintained and agood defecation function is achieved for alarge proportion of patients using the pouch-anal anastomosis or the side-to-end techniques.

Research progress of different bowel reconstructions for postoperative functional protection during low anterior resections of rectal cancer

Straight coloanal anastomosis (SCA), colonic J-pouch anastomosis (CJP), transverse coloplasty pouch anastomosis (TCP), and side-to-end anastomosis (SEA) are the most commonly used procedures of bowel reconstructions in the low anterior resections (LAR) of rectal cancer. Different bowel reconstruction procedures greatly affect postoperative bowel function, urinary function and sexual function. SCA is the most traditional procedure. CJP has been studied extensively and well-developed reconstruction method; however, recent studies have shown that CJP has the highest morbidity of complications, so the clinical application of CJP is limited. SEA is not inferior to CJP and SCA in the short-term and long-term defecation function, urination function, and sexual function, with reliable operational safety, so it is expected to become an alternative to SCA and CJP. The research on TCP is lacking, but there are some related clinical trials currently underway, and the results are worth expecting. The improvement and innovation of bowel reconstructions provide a bright prospect for better functional prognosis in patients with rectal cancer.

The transverse coloplasty pouch is technically easy and safe and improves functional outcomes after low rectal cancer resection-a single center experience with 397 patients.

Following resection for low rectal cancer, numerous patients suffer from frequent bowel movements, fecal urgency, and incontinence. Although there is good evidence that colonic J-pouch reconstruction, side-to-end anastomosis, or a transverse coloplasty pouch (TCP) improves functional outcome, many surgeons still prefer straight coloanal anastomosis because it is technically easier and lacks the risk of pouch-associated complications. The present single-center study aimed to evaluate the practicability of TCPs in routine clinical practice as well as pouch-related complications. All consecutive patients who underwent low anterior rectal resection with restoration of bowel continuity for cancer during the period September 2008 to June 2018 were included. A TCP in combination with a diverting ileostomy was defined as the hospital standard. The feasibility and safety of TCPs were assessed in a retrospective single-center study. A total of 397 patients were included in the study. A total of 328/397 patients underwent TCP construction (82.6%). Two pouch-related surgical complications occurred (0.6%); one case of pouch-related stenosis and one case of sutural insufficiency. Overall, leakage of the coloanal anastomosis was reported in 14.1% of patients with a TCP and in 18.8% of patients without a pouch (p=0.252). Diverting ileostomy was applied in 378/397 patients (95.2%). The 30-day mortality was 0.25%. The present study is by far the largest single-center experience with TCP construction for low rectal cancer resection. The study shows that a TCP is technically applicable in the vast majority of cases (82.6%). Pouch-associated surgical complications are sporadic events. In our opinion, the TCP can be considered an alternative to J-pouch construction after low anterior rectal resection.

Taeniectomy Versus Transverse Coloplasty as Neorectum After Low Rectal Resection

Restorative surgery for rectal cancer is usually criticized by its functional outcomes. The aim of this study is to assess the efficacy "taeniectomy" pouch in comparison with transverse coloplasty pouch. This was a prospective controlled study. Most patients who were candidate for low rectal resection presented to colorectal unit at Cairo university hospitals during the period from February 2013 to August 2016 were divided into two groups. The total number of patients enrolled in the study was 180 patients. Ninety patients were subjected to low rectal resection with the transverse coloplasty pouch, and 90 patients were subjected to low rectal resection with the newly described taeniectomy pouch. Safety and feasibility of both techniques were assessed about leakage, operative time, difficulty in evacuation, incontinence, number of daily motions and postoperative urgency. Both groups were assessed clinically, by means of defecography and anorectal manometry. There was no significant statistical difference between taeniectomy and transverse coloplasty regarding postoperative leakage (P value = 0.988), postoperative mortality (P value = 0.99) and functional outcomes including number of motions per day (P value was 0.403 at 3months and 0.361 at 12months), urgency (P value was 0.688), continence grade (P value was 0.320 and 0.683 in 3 and 12months, respectively) and manometric findings. However, taeniectomy is statistically significant better in terms of operative time (P value = 0.001). Taeniectomy is a newly described, technically easier technique for pouch formation after low rectal resection that can be used as a safe and effective alternative for the widely used transverse coloplasty.

Complete laparoscopic total mesorectal excision with an intersphincteric resection and coloplasty pouch anal anastomosis for lower rectal cancer.

This pilot study aimed to develop a new technique, complete laparoscopic total mesorectal excision (TME) with an intersphincteric resection (ISR) and coloplasty pouch anal anastomosis to avoid any further abdominal incision other than laparoscopic port sites, and to assess the impact on short-quality of life and oncological outcomes of this technique. After laparoscopic TME, large bowel was dissected at the level of the promontory. Then, laparoscopic construction of the coloplasty pouch was performed. Simultaneously, a rectal specimen with ISR was excised using the transanal approach. Coloplasty pouch was gently pulled from pelvic thorough anal and a hand-sewn coloplasty pouch anal anastomosis was created. We had performed 8 surgeries using the new technique. Though one patient developed pelvic infections, but intestinal continuity could be maintained and no local and distant recurrence was recognized in other patients. We foresee this novel approach to have significant clinical potential for lower rectal cancer patients with ISR.

Modified transverse coloplasty pouch: new reconstruction techniques after total mesorectal excision. Our experience.

The incidence of rectal cancer continues to rise. The functional results after complete Total Mesorectal Excision (TME) depend on the segment of colon used for reconstruction of colonic continuity and the form, the volume and the functional proprieties of the "neorectum". The aim of our study is evaluate the efficacy of our Modified Transverse Coloplasty Pouch (MTCP) after the treatment of low rectal cancer in terms of functional outcomes and quality of life. The study included 136 patients, underwent TME from January 2007 to December 2016 with diagnosis of extraperitoneal carcinoma of the rectum. The average distance of the tumor from the dentate line was 5.6 cm. Our follow-up protocol included functional outcome evaluation at 7th post-operative day (POD), 2nd month, and 6th month after the surgery. All patients (M/F 84/52) underwent anterior rectal resection (TME) with MTCP. Frequency of bowel movements per 24 hours in the studied patients compared at 7th POD, 2 months, and 6 months. Since the first post-operative weeks there is an encouraging reduction of the frequency of bowel movements. Modified Transverse Coloplasty Pouch (MTCP) had better functional results and quality of life compared to patients with a Colonic J Pouch (CJP) and traditional Transverse Coloplasty Pouch (TCP).

Erratum to: Comparison of a colonic J-pouch and transverse coloplasty pouch in patients with rectal cancer after an ultralow anterior resection using fecoflowmetric profiles

Erratum to: Comparison of a colonic J-pouch and transverse coloplasty pouch in patients with rectal cancer after an ultralow anterior resection using fecoflowmetric profiles

Comparison of a colonic J-pouch and transverse coloplasty pouch in patients with rectal cancer after an ultralow anterior resection using fecoflowmetric profiles

Because the standard straight coloanal anastomosis for low rectal cancer tends to result in unfavorable outcomes in terms of defecatory function, colonic pouch reconstruction has therefore recently been adopted in many institutions. The colonic J-pouch (CJP)- and transverse coloplasty pouch (TCP)-anal anastomoses have been adopted worldwide. However, the comparative benefits and drawbacks of the two procedures are uncertain. This study was designed to analyze the functional and clinical outcomes after an ultralow anterior resection (ULAR) using the fecoflowmetry (FFM). Between November 1996 and July 2005, 18 patients were studied retrospectively. They were evaluated by FFM, together with Kelly's clinical score (KCS), and anorectal manometric assessments were also performed. The KCS directly correlated to the maximum fecal stream flow rate (Fmax). In this study, postoperative patients with good KCS as well as a high value of Fmax were seen more in the patients with CJP than in those with TCP. From the viewpoint of FFM, the patients with CJP had a more favorable functional outcome than those with TCP. FFM provided quantitative and qualitative evaluations concerning the anorectal motor activity in patients who had undergone an ULAR for rectal cancer.

Colonic J-Pouch, Coloplasty, Side-to-End Anastomosis: Meta-Analysis and Comparison of Outcomes

Preservation of rectal function after low anterior resection or proctectomy with formation of a neorectum has improved the quality of life of many patients with rectal cancers. This would mean preserving the anal sphincters and avoiding a permanent stoma while reconstructing a neorectum to improve the bowel function of patients. Following proctectomy, the traditional anastomosis will be a straight coloanal end-to-end anastomosis to restore bowel continuity. However, this is associated with very poor bowel function. The construction of a colonic J-pouch anastomosis is introduced to reduce this problem. While colonic J-pouch anastomosis is able to obviate some of the functional problems of straight coloanal anastomosis, it comes with an additional problem of pouch evacuation. Therefore, alternatives techniques, such as transverse coloplasty pouch and side-to-end coloanal anastomosis, have been adopted. The postoperative surgical and functional outcomes are discussed and appraised.

Functional Outcome After Restorative Proctocolectomy in Pigs: Comparing a Novel Transverse Ileal Pouch to the J-Pouch and Straight Ileoanal Anastomosis

BackgroundRestorative proctocolectomy followed by an ileoanal J-pouch procedure is the therapy of choice for patients with familial adenomatous polyposis and ulcerative colitis. After low anterior rectal resection, the authors have reported on a novel, less complex pouch configuration, a transverse coloplasty pouch. The aim of the present work was to apply this new design to the ileal pouch construction, to evaluate feasibility, and to measure functional results in comparison with the J-pouch and the straight ileoanal anastomosis using the pig as an animal model. MethodsTwenty-three pigs underwent restorative proctocolectomy followed by reconstruction with straight ileoanal anastomosis (IAA; n = 5), J-pouch (n = 7), and a transverse ileal pouch (TIP; n = 11). Pigs were followed for 6 days postoperatively. Peristaltic function was assessed by manometry proximal to the pouch, in the reservoir, and at the level of the ileoanal anastomosis. Functional outcome was monitored by semiquantitative assessment of the general condition of the animals, postoperative feeding habits, and stool frequency and consistency. A Fourier analysis was performed in order to compare peristalsis in the ileal reservoirs. The reservoir volume was measured in situ by triple contrast computed tomography scan with 3D reconstruction. ResultsSeventeen animals survived for 1 week. There was no difference in the general condition or the feeding habits of the groups. A significant number of pigs with the TIP pouch (7/10) had semisolid or formed stools as opposed to liquid stools after J-pouch (6/6) and IAA (4/5; p = 0.01). TIP animals had a lower stool frequency (3.2±1.14 per day) on day 6 after the operation than pigs with J-pouch, 5.33 ± 1,03, and IAA, 4.6±1.82 (p = 0.0036). The in situ volume of the pouches did not differ significantly. The Fourier analysis demonstrated a disruption of peristalsis by the J-pouch and the TIP reconstruction but not after IAA. ConclusionThe function of ileoanal reservoirs after proctocolectomy may result from the disruption of properistaltic waves after pouch formation. The mechanism of peristalsis disruption is independent of the in situ volume of the pouch.

Early results from a randomized clinical trial of colon J pouch versus transverse coloplasty pouch after low anterior resection for rectal cancer

Patients with primary rectal cancer undergoing low anterior resection are often reconstructed using a pouch procedure. The aim of this trial was to compare colon J pouch (CJP) with transverse coloplasty pouch (TCP) reconstruction with regard to functional results, perioperative mortality and morbidity. As there is considerable uncertainty over the true anastomotic leak rate in patients with a TCP, the study analysed short-term outcome data. Elective patients suitable for either procedure after sphincter-saving low anterior resection were eligible. Randomization took place during surgery. The primary endpoint was the rate of late evacuation problems after 2 years; secondary endpoints were anastomotic leak rate, perioperative morbidity and mortality. Between 21 October 2002 and 5 December 2005, 149 patients were randomized. All 76 patients randomized to TCP had the procedure compared with 68 of the 73 patients (93 percent) randomized to CJP. Both groups were comparable with regard to demographic and clinical characteristics. Surgical complications (CJP: 19 percent; TCP: 18 percent) and the overall anastomotic leak rate (8 percent) were equally distributed in both groups. This trial demonstrated a comparable early outcome for TCP and CJP. This contradicts previous reports suggesting a higher leak rate after TCP. ISRCTN78983587 (http://www.controlled-trials.com).

The colon J-pouch as a cause of evacuation disorders after rectal resection: myth or fact?

Colon J-pouch (JCP) reconstructions result in a better functional outcome than straight coloanal anastomosis (SCA) in terms of continence and frequency of defecation after rectal resection but might be associated with more evacuation difficulties. In order to evaluate this hypothesis, we systematically reviewed the literature to collect data on evacuation disorders after rectal resection in randomized or otherwise comparative trials. Randomized controlled trials and comparative trials evaluating CJP versus SCA, latero-terminal anastomosis (LTA), and transverse coloplasty pouch (TCP) were ascertained by methodical search using Medline, Embase, and PubMed. Pooled estimates of outcomes were calculated for early-, intermediate-, and long-term follow-up. Primary meta-analysis outcomes were sensation of incomplete evacuation, prolonged evacuation, use of laxatives, use of enemas and suppositories, and stool fragmentation. When compared to SCA, CJP was associated with significantly less "prolongation of evacuation" but more "use of laxatives" in the intermediate-term follow-up, while both less "sensation of incomplete evacuation" and less "fragmentation" was found after CJP in the long-term. When compared to TCP, CJP was associated with significantly less fragmentation in the intermediate-term follow-up. Evacuation disorders are a unique problem of low anterior resection and are not specifically related to the colon J-pouch.

Intersphincteric Resection of Low Rectal Cancer with Coloplasty Pouch

Schiessel, Rudolf M.D.1,2; Hofmann, Michael2; Novi, Gabriele M.D.1; Holzer, Brigitte M.D.1,2Editor(s): Hull, Tracy M.D. Author Information

Complications of elective surgery for rectal cancer

BACKGROUND: Standardization of surgery and new procedures have led to significant advances in the treatment of rectal cancer. METHODS: Review on avoidance and management of complications in rectal cancer surgery. RESULTS: Anatomical dissection of the mesorectum permits optimal local control and reduction of local recurrence. Sphincter preservation can be achieved by the technique of intersphincteric resection even for low tumours. A J-pouch or a recently designed coloplasty pouch improve functional results after coloanal anastomoses. Neoadjuvant treatments have a role in local control of the disease after TME surgery and in new strategies of sphincter-saving procedures. Although perioperative morbidity in elective surgery for rectal cancer is very low, radical local control of the disease and the patient's wish for sphincter preservation have to be weighed against possible complications. The literature was carefully reviewed to evaluate data on the procedure-specific complications in elective surgery for rectal cancer and the impact of neoadjuvant treatment regimens and perioperative management on postoperative morbidity. CONCLUSIONS: Meticulous attention to detail achieve low complication rates in modern rectal surgery. In experienced hands, the total mesorectal excision operation is not associated with increased postoperative morbidity and mortality.

The transverse coloplasty pouch

The introduction of the total mesorectal excision (TME) and the use of modern staplers have improved outcome and increased the rate of sphincter-preserving low anterior resections in rectal cancer. Consequently, the interest in functional results after rectal reservoir reconstruction increased significantly. A review of the current literature was conducted on the development of colon pouch procedures with a particular focus on the transverse coloplasty pouch compared with the colon J-pouch and other current techniques of reconstruction after TME such as the side-to-end anastomosis. The colon J-pouch (CJP) became the "gold standard" for rectal reservoir reconstruction owing to better early functional results compared with the straight coloanal anastomosis (CAA). However, 30% of the patients with CJP faced late evacuation problems requiring the chronic use of enemas or laxatives. This rate could be decreased by shortening the limb of the CJP from 8-10 to 5-6 cm, but the late evacuation problems remained in approximately 10% of the patients. An overview of the current knowledge on technical and functional aspects as well as indications and results of the transverse coloplasty pouch (TCP) is presented. The TCP was developed to provide early functional results comparable to the CJP while avoiding the late evacuation problems. Functional results after TCP, small colon J-pouch and side-to-end anastomosis are similar. Evacuation problems after TCP have not been reported.

Quality of Life, Functional Outcome, and Complications of Coloplasty Pouch After Low Anterior Resection

The colonic J-pouch has been used to improve bowel function in patients undergoing low colorectal or coloanal anastomosis. However, a narrow pelvis, difficulties in reach, a long anal canal with prominent sphincters, or a fatty mesentery may turn this technique into a technically challenging procedure in certain patients. In these circumstances, "coloplasty" offers an alternative to a straight anastomosis. The purpose of this study was to compare the quality of life, functional outcome, and complications between patients undergoing coloplasty, colonic J-pouch, or straight anastomosis. Altogether, 162 patients who underwent coloanal or low colorectal anastomosis between 1998 and 2001 were studied. Data collected included demographics, length of follow-up, technique and type of anastomosis, complications, quality of life, and functional outcome. Results were analyzed according to use of a coloplasty (n = 69), colonic J-pouch (n = 43), or straight anastomosis (n = 50). The choice of the technique was based on the surgeon's preference. Usually coloplasty or straight anastomosis was favored in male patients with a narrow pelvis or when a handsewn anastomosis was used. Quality of life assessment with the short form-36 questionnaire revealed better scores in coloplasty and colonic J-pouch groups. The coloplasty (1.0 +/- 1.7) and colonic J-pouch (1.0 +/- 1.2) groups had fewer night bowel movements than the straight anastomosis group (1.5 +/- 2.0) (P < 0.05). The coloplasty group also had fewer bowel movements per day than the straight anastomosis group (3.8 +/- 2.9 vs. 4.8 +/- 3.6; P < 0.05); also, less clustering and less antidiarrheal medication use were observed than in the straight anastomosis group. Colonic J-pouch patients with handsewn anastomosis had a higher anastomotic leak rate (44 percent) than the patients in the coloplasty with handsewn anastomosis group (3.6 percent). Coloplasty seems to be a safe, effective technique for improving the outcome of low colorectal or coloanal anastomosis. It is especially applicable when a colonic J-pouch anastomosis is technically difficult.