Coloplasty in low colorectal anastomosis - Manometric and functional comparison with straight and colonic J-pouch anastomosis

PURPOSE: After resection of the distal rectum with a straight reanastomosis . poor bowel function can occur. This is felt to be because of the loss of the rectal reservoir. To overcome this, a neoreservoir using a colonic J-po uch has been advocated in low colorectal and coloanal anastomosis. However, difficulties in reach, inability to fit the pouch into a narrow pelvis, an d postoperative evacuation problems can make the colonic J-pouch problemati c. Coloplasty is a new technique that may overcome the poor bowel function seen in the straight anastomosis and the problems of the colonic J-pouch. T he purpose of this study was to compare the functional results after a low colorectal anastomosis among patients receiving a coloplasty, colonic J-pou ch, or straight anastomosis. METHODS: Twenty patients underwent constructio n of a coloplasty with a low colorectal anastomosis. Postoperative manometr y and functional outcome of these patients was compared with a matched grou p of 16 patients who had a colonic J-pouch and low colorectal anastomosis a nd 17 patients who had a straight low colorectal anastomosis. RESULTS: Maxi mum tolerated volume was significantly favorable in the coloplasty (mean, 1 16.9 mi) and colonic J-pouch group (mean, 150 ml) vs, the straight anastomo sis group (mean, 83.3; P < 0.05) The compliance was also significantly favo rable for the coloplasty (mean, 4.9 ml/mmHg) and the colonic J-pouch group (mean, 6.1 ml/mmHg) vs. the straight anastomosis group (mean, 3.2 ml/mmHg; Pi 0.05) The coloplasty (mean, 2.6; range, 1-5) and colonic J-pouch (mean, 3.1; range, 2-6) had significantly fewer bowel movements per day than the s traight anastomosis group (mean, 4.5; range, 1-8; P < 0.05). Similar compli cation rates were noted in the three groups. CONCLUSIONS: Patients with a c oloplasty and low colorectal anastomosis seem to have similar functional ou tcome along with similar pouch compliance compared with patients with colon ic J-pouch and low colorectal anastomosis. However, the coloplasty may prov ide an alternative method to the colonic J-pouch for a neorectal reservoir construction when reach or a narrow pelvis prohibits its formation. Technic ally it also may be easier to construct.