NEW TECHNIQUE FOR POUCH-ANAL RECONSTRUCTION AFTER TOTAL MESORECTAL EXCISION

PURPOSE: Surgical options in metachronous or recurrent rectal cancer a fter anterior or low anterior resection are Limited and frequently res ult in abdominoperineal rectal extirpation sacrificing the sphincter o r in straight coloanal reconstruction. Decreased capacity and distensi bility in straight coloanal reconstruction after proctectomy correlate well with increased daily stool frequency, urgency, and incontinence. A new technique for coloanal pouch reconstruction using the ileocecal segment is proposed. METHODS: A pedunculated ileocecal segment was ro tated 180 degrees counterclockwise and placed between the sigmoid colo n and anal canal. heal end of the pouch was then anastomosed end-to-en d with the transected sigmoid colon and proximal end of the ileum with distal end of the ascending colon. Functional results and defecation quality of a 67-year-old woman are described 6 and 12 months after ile ocolonic interposition pouch replacing the tumor-bearing rectum. RESUL TS: Twelve months postoperatively, the patient is free of disease with an excellent defecation quality, has full anal continence without soi ling, is having two solid stools in 24 hours. Functional control revea led normal anal sphincter pressure and large rectal capacity and compl iance. Neither outlet obstruction nor incomplete evacuation have been observed. CONCLUSION: The ileocecal interposition pouch (cecum pouch) represents an alternative technique for coloanal reconstruction in low rectal cancer, recurrent rectal cancer, or metachronous low rectal ca ncer with intact sphincter function. This new method presents some att ractive features compared with techniques presently in use.