ILEOCECAL RESERVOIR RECONSTRUCTION WITH PHYSIOLOGICAL-FUNCTION AFTER TOTAL MESORECTAL CANCER EXCISION

Background/Aims After proctectomy for low rectal cancer and straight c oloanal reconstruction, the main causes for increased daily stool freq uency, urgency, and incontinence are the limited capacity and distensi bility of the anastomosed colic segment in the pelvis. The authors pos tulated that a pedunculated (preserving the nerve) ileocecal interposi tional graft (cecum-reservoir) placed between the sigmoid colon and th e anal canal would greatly reduce these inconveniences. Methods The au thors evaluated the safety, defecation quality, and anorectal physiolo gy of such a neorectum in 20 consecutive patients with rectal carcinom a between 5 and 10 cm above the anal verge who underwent total mesorec tal excision. Results No perioperative morbidity related to the techni que and no mortality was observed in these 20 patients. Six months aft er the operation, 16 patients showed excellent and 4 patients good def ecation quality, with maximal tolerable volumes, compliance, and mean colonic transit times comparable to age- and gender-matched healthy vo lunteers. In addition, anal resting pressure was decreased, squeeze pr essure was maintained, and the rectoanal inhibitory reflex remained po sitive in 80%. Conclusions The cecum-reservoir as a neorectum, using a n intact neurovascular colonic segment, is a safe technique, providing excellent defecation quality. It enables a nearly normal physiologic anorectal function, which is already seen 6 months postoperatively.