LATE CLINICAL OUTCOME IN A RANDOMIZED PROSPECTIVE COMPARISON OF COLONIC J-POUCH AND STRAIGHT COLOANAL ANASTOMOSIS

Background Functional outcome after rectal excision with coloanal anas tomosis is improved by construction of a colonic J pouch. Present pros pective randomized studies lack follow-up beyond 1 year. The aim of th is study was to assess the clinical outcome at both short-and long-ter m follow-up Methods Forty patients with low rectal cancer were randomi zed prospectively to either J colonic pouch-anal anastomosis or a stra ight coloanal anastomosis. Clinical assessments were performed 3, 12 a nd 24 months after colostomy closure using a standard questionnaire an d physical examination. Results There was no significant difference in the complication rate between the two groups. There was a significant (P < 0.01) improvement in frequency of defaecation at 3, 12 and 24 mo nths for patients with a reservoir. Similarly, fragmentation (clusteri ng of stools) was significantly less at 3 and 12 months (P < 0.01) in the reservoir group, and incontinence occurred less frequently in the first year (P = 0.09). By 24 months no patient in either group suffere d from major or minor incontinence. Conclusion The functional improvem ent gained from a colonic reservoir in coloanal anastomosis continues to benefit the patient for at least 2 years.