Horizontal inclination of the longitudinal axis of the colonic J-pouch - Defining causes of evacuation difficulty

PURPOSE: Functional outcome after low anterior resection for rectal cancer is improved by the construction of a colonic J-pouch. One disadvantage of t his type of reconstruction is evacuation difficulty, which has been associa ted with large pouches. The purpose of this study was to elucidate the caus es of evacuation difficulty in large pouches using pouchography. METHODS: T he angle between the longitudinal axis of the pouch and the horizontal line (pouch-horizontal angle) on lateral pouchography was determined in 26 pati ents with 10-cm J-pouch reconstructions (10-J group) and 27 patients with 5 -cm J-pouch reconstructions (5-J group). Measurement were made at three mon ths, one year, and two years after surgery. Clinical function was evaluated using a questionnaire one year postoperatively. RESULTS: The pouch-horizon tal angle in the 10-J group was significantly smaller than that in the 5-J group at all three time points. In both groups the pouch-horizontal angle a t one pear was significantly smaller than that at three months. There were no significant differences between the pouch-horizontal angles at one and t wo years. An evacuation difficulty was significantly more common in the 10- J group than the 5-J group. CONCLUSIONS: The evacuation difficulty observed in patients with large colonic J-pouch reconstructions may be attributed t o the develop ment of a horizontal inclination within one year of surgery.