PHYSIOLOGICAL AND FUNCTIONAL OUTCOME FOLLOWING ULTRA-LOW ANTERIOR RESECTION WITH COLON POUCH-ANAL ANASTOMOSIS

Background Low rectal cancer is usually managed by ultra-low anterior resection (ULAR) with total mesorectal excision and straight coloanal anastomosis. However, following this procedure patients often suffer f rom frequency, urgency of bowel action and, occasionally, faecal incon tinence. To overcome such problems, a colon pouch may be fashioned and a subsequent colon pouch-anal anastomosis performed. The physiologica l and functional outcome following the use of a colon pouch are apprai sed. Methods All relevant papers identified from a Medline search and papers from cross-referencing were reviewed. Results and Conclusion Cr eation of a colon pouch following ULAR results in reduced bowel freque ncy, and a lower incidence of urgency and faecal incontinence. Althoug h there is a slightly increased incidence of evacuatory disorder and n eed for enemas or suppositories, this appears to be a minor problem wh ich may possibly be overcome by using a smaller colon pouch. Compared with straight coloanal anastomosis following ULAR, the creation of a c olon pouch produced a superior functional outcome.