Misconceptions about the colonic J-pouch

INTRODUCTION: Since 1986 when the colonic J-pouch-anal anastomosis was first described, it has gained increasing acceptance as the operation of choice for low rectal cancer surgery. However, there still exist several misconceptions about its use, namely anastomotic complications, alterations in anorectal physiology, and functional outcome. METHODS: All relevant articles derived from MEDLINE databases from 1986 to the present were reviewed. Emphasis was placed on reviewing the features that are claimed to make the colonic J-pouch-anal anastomosis superior to a straight anastomosis. RESULTS AND CONCLUSIONS: The colonic J-pouch has a role in ultra-low rectal cancer surgery, with an apparent reduction in the incidence of anastomotic leaks and reduced bowel frequency. Continence is unchanged and defecatory difficulties can be reduced by constructing a small pouch (≤5 cm).

[1]  S. Amano,et al.  Anorectal pressure and rectal compliance after low anterior resection , 1980, The British journal of surgery.

[2]  K. Okuno,et al.  Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch , 1996, Diseases of the colon and rectum.

[3]  R. Gamagami,et al.  Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis , 1997, The British journal of surgery.

[4]  M. Starlinger,et al.  Level of the anastomosis does not influence functional outcome after anterior rectal resection for rectal cancer. , 1995, American journal of surgery.

[5]  N. Mortensen,et al.  Ambulatory manometric examination in patients with a colonic J pouch and in normal controls , 1996, The British journal of surgery.

[6]  W. Kirwan,et al.  Mechanism of sphincter impairment following low anterior resection , 1992, Diseases of the colon and rectum.

[7]  D. Johnston,et al.  Survival and recurrence after sphincter saving resection and abdominoperineal resection for carcinoma of the middle third of the rectum , 1984, The British journal of surgery.

[8]  R. Heald,et al.  The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? , 1982, The British journal of surgery.

[9]  R. Sjödahl,et al.  Laser Doppler blood flow measurement in rectal resection for carcinoma–comparison between the straight and colonic J pouch reconstruction , 1996, The British journal of surgery.

[10]  F. Ficari,et al.  What affects continence after anterior resection of the rectum? , 1991, Diseases of the colon and rectum.

[11]  L. Morgenstern,et al.  Use of a mechanical suturing apparatus in low colorectal anastomosis. , 1975, Archives of surgery.

[12]  D. Lubowski,et al.  Comparison of colonic reservoir and straight colo‐anal reconstruction after rectal excision , 1988, The British journal of surgery.

[13]  N. Iwai,et al.  Physiologic status of the anorectum following sphincter-saving resection for carcinoma of the rectum , 1982, Diseases of the colon and rectum.

[14]  W. Gowers.  IV. The automatic action of the sphincter ani , 1878, Proceedings of the Royal Society of London.

[15]  F. Lazorthes,et al.  Resection of the rectum with construction of a colonic reservoir and colo‐anal anastomosis for carcinoma of the rectum , 1986, The British journal of surgery.

[16]  R. Bennett,et al.  The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence , 1963, Gut.

[17]  H. Goh,et al.  Prospective randomized trial comparing J colonic pouch‐anal anastomosis and straight coloanal reconstruction , 1995, The British journal of surgery.

[18]  Y. Ho,et al.  Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: Comparison of straight and colonic J pouch anastomoses , 1996, The British journal of surgery.

[19]  W. Lewis,et al.  Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: Myth or reality? , 1995, Diseases of the colon and rectum.

[20]  W. Lewis,et al.  Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma? , 1995, Diseases of the colon and rectum.

[21]  R. Parc,et al.  Prediction of optimum dimensions of colonic pouch reservoir , 1996, Diseases of the colon and rectum.

[22]  W. Lewis,et al.  Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal carcinoma , 1992, The British journal of surgery.

[23]  E. Tiret,et al.  Resection and colo‐anal anastomosis with colonic reservoir for rectal carcinoma , 1986, The British journal of surgery.

[24]  J. Whitaker,et al.  The double stapling technique for low anterior resection. Results, modifications, and observations. , 1990, Annals of surgery.

[25]  E. Weiss,et al.  Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch , 1998, Diseases of the colon and rectum.

[26]  L. Påhlman,et al.  Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. , 1996, Annals of surgery.

[27]  J. Leroy,et al.  Functional assessment of coloanal anastomosis with reservoir and excision of the anal transition zone , 1991, Diseases of the colon and rectum.

[28]  N. Takeuchi,et al.  Colonic J-pouch rectal reconstruction—Is it really a neorectum? , 1996, Diseases of the colon and rectum.

[29]  C. Chocarro,et al.  Coloanal anastomosis: Are functional results better with a pouch? , 1995, Diseases of the colon and rectum.

[30]  W. Lewis,et al.  Decrease in the anorectal pressure gradient after low anterior resection of the rectum , 1994, Diseases of the colon and rectum.

[31]  W. Lewis,et al.  Factors that influence functional outcome after coloanal anastomosis for carcinoma of the rectum , 1995, The British journal of surgery.

[32]  R. Gamagami,et al.  Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis , 1997, Diseases of the colon and rectum.

[33]  A. Parks.  Transanal technique in low rectal anastomosis. , 1972, Proceedings of the Royal Society of Medicine.

[34]  O. Hallböök,et al.  Comparison between the colonic J pouch‐anal anastomosis and healthy rectum: Clinical and physiological function , 1997, The British journal of surgery.

[35]  Z. Cohen,et al.  Double stapling technique for low anterior resection , 1983, Diseases of the colon and rectum.

[36]  N. Mortensen,et al.  Colonic J pouch‐anal anastomosis after rectal excision for carcinoma: Functional outcome , 1995, The British journal of surgery.

[37]  R. Nicholls,et al.  The Relationship Between the Extent of Distal Clearance and Survival and Local Recurrence Rates After Curative Anterior Resection for Carcinoma of the Rectum , 1983, Annals of surgery.

[38]  P. Nyström,et al.  Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer , 1997, Diseases of the colon and rectum.

[39]  É. Pélissier,et al.  Functional results of coloanal anastomosis with reservoir , 1992, Diseases of the colon and rectum.

[40]  M. O'riordain,et al.  Rectoanal inhibitory reflex following low stapled anterior resection of the rectum , 1992, Diseases of the colon and rectum.

[41]  S. Chew,et al.  Colonic J-pouch as a neorectum: functional assessment. , 1997, The Australian and New Zealand journal of surgery.

[42]  J. Utsunomiya,et al.  Function after anoabdominal rectal resection and colonic J pouch‐anal anastomosis , 1991, The British journal of surgery.

[43]  D. Bartolo,et al.  Anorectal sampling: A comparison of normal and incontinent patients , 1988, The British journal of surgery.