A new surgical concept for rectal replacement after low anterior resection- The transverse coloplasty pouch

Objective To analyze the feasibility, safety, complication and death rates, and early functional results of the transverse coloplasty pouch procedure after low anterior rectal resection and total mesorectal excision. Summary Background Data The authors previously developed a novel neorectal reservoir, the transverse coloplasty pouch, in an animal model; they report the first clinical data of a prospective phase 1 study. Methods Forty-one patients underwent low anterior rectal resection with tot al mesorectal excision for rectal cancer (n = 37) or benign pathology (n = 4). The continuity was restored with a transverse coloplasty pouch anastomo sis, and the colon was defunctionalized for 3 months. Patients were followe d up at 2-month intervals for functional outcome. Results Intraoperative complications occurred in three patients (7%), none related to the transverse coloplasty pouch. There were no hospital deaths a nd the total complication rate was 27% (11/41); an anastomotic leakage rate of 7% was recorded. The stool frequency was 3.4 per 24 hours at 2 months f ollow-up and gradually decreased to 2.1 per 24 hours at 8 months, Stool dys functions such as stool urgency, fragmentation, and incontinence grade 1 an d 2 were regularly observed until 6 months; the incidence significantly dec reased thereafter. None of the patients had difficulties in pouch evacuatio n. Conclusions The transverse coloplasty pouch is a small-volume reservoir tha t can safely be used for reconstruction after sphincter-preserving rectal r esection. The early functional outcome is favorable and can be compared to other colonic reservoirs. The concept of reducing early dysfunction seen af ter straight coloanal anastomosis and avoiding long-term problems of pouch evacuation is supported by this study. Future trials will compare the trans verse coloplasty pouch with other techniques of restorative resections of t he rectum.