Comparison of colonic J-pouch reconstruction and straight coloanal anastomosis after intersphincteric rectal resection

The tendency towards sphincter-preserving resection for distal rectal cance rs has led to the technique of straight coloanal anastomosis (CAA) and colo nic J-pouch anal anastomosis (CPA) after low anterior resection. The aim of the present study was to compare complication rate, anorectal physiology a nd functional results after both types of reconstruction after ultralow int ersphincteric resection. A total of 31 patients who had undergone CPA were followed up prospectively using anorectal manometry and a standardised ques tionnaire and were compared with 63 patients who had undergone CAA and were followed up in the same way. The complication rate after CPA did not diffe r significantly from that after CAA. One year postoperatively, the median s tool frequency and urgency were reduced after CPA (1.7+/-2.2/day; 7% vs. 2. 4+/-3.6/day; 14%; P<0.05). Three months after colostomy/ileostomy closure, the maximum tolerable volume, threshold volume and compliance were decrease d after CAA when compared with CPA (55+/-12, 34+/-12, and 3.9+/-0.3 ml/mmHg vs. 85+/-21. 53+/-11 and 6.2 ml/mmHg, respectively; P<0.05). Anal manometr y revealed no significant differences in the anal resting and squeeze press ure. One year postoperatively, continence also did not differ significantly between CPA and CAA. Colonic J-pouch reconstruction seems to be superior t o the straight coloanal anastomosis, especially during the first postoperat ive year. In view of the often poor prognosis of the patients, it is the re construction of choice after ultra-low resections of the rectum.