COLON-J-POUCH-ANAL RECONSTRUCTION AFTER T OTAL RECTUM RESECTION - FUNCTIONAL-ASPECTS

Coloanal reconstruction is a sphincter saving operation following tota l rectal resection to treat rectal cancer 3 to 11 cm above the dentate line. Total rectal resection in this situation is justified from the oncological and surgical viewpoint because the local recurrence rate a nd morbidity are not different from the ''gold standard'', abdominoper ineal resection sacrificing the anal sphincter. Although patients unde rgoing straight coloanal reconstruction preserve continence, they are often disturbed by high stool frequencies and imperative urge. We set out to establish whether construction of a colon-j-pouch could amelior ate the quality of defecation and thus prove useful. In this study the pre- and postoperative results of a pilot study with 4 consecutive pa tients following colon-j-pouch-anal reconstruction are presented. Peri operatively, 3 of 4 patients suffered from intermittent disturbances o f urinary voiding. Sexual function was disturbed in 3 of 4 patients. A ll patients were completely continent. The preliminary results showed a decreased sphincter pressure at rest of 40 mm Hg (SD: 5) and a norma l squeeze pressure. Endoanal ultrasound demonstrated a normal anal sph incter morphology. Pouch compliance yielded 4.7 ml/cm H2O and was bett er than after straight coloanal reconstruction in the control group (2 .8 ml/cm H2O). The stool frequency at 6 months was 3/24 hours without imperative urge. The colon transit time lasted 49 hours and was in the normal range. No pouch evacuation disorders were observed. These resu lts show a minimal morbidity in colon-j-pouch-anal reconstruction with preservation of complete continence in the follow-up time. Hence the indication for a sphincter saving total rectal resection could be esta blished more easily in the treatment of rectal cancer in the lower and middle part of the rectum. Further investigations are necessary to de monstrate the functional utility of the colon-j-reservoir.