AMBULATORY MANOMETRIC EXAMINATION IN PATIENTS WITH A COLONIC J-POUCH AND IN NORMAL CONTROLS

Anorectal function after anterior resection may be impaired as a resul t of reduced luminal capacity in the pelvis. The aim of this study was to evaluate the colonic J pouch neorectum by means of ambulatory mano metry. Twelve patients with a colonic pouch following anterior resecti on and seven healthy controls were studied for a median of 6 (range 6- 24) h using a probe with two pouch-rectal and two anal canal transduce rs. Records were interpreted by visual inspection. Pressure values and wave frequencies were determined by software analysis. Pouches had be en functioning for a median of 32 (range 11-55) months. All patients w ith a pouch had an acceptable stool frequency. Seven of 12 patients co mplained of incomplete evacuation. Resting anal canal pressure (73 ver sus 100 cmH(2)O), pouch-rectal pressure (29 versus 15 cmH(2)O) and ana l canal pouch-rectal pressure gradients (60 versus 85 cmH(2)O) were si milar in patients and controls. The frequency of slow-wave activity in patients with a pouch was significantly lower than that in controls ( 7 versus 16 cycles per min, P = 0.001). Coordination between the colon ic J pouch and the anal canal, in the form of sampling episodes, was o bserved in more than half of the patients with a functioning pouch. La rge isolated contractions (pressure greater than 30 cmH(2)O and lastin g longer than 20s) and rhythmic contractions were the most frequent pa ttern of pouch motility.