Colonic J-Pouch vs . Coloplasty Following Resection of Distal Rectal Cancer

Abstract

We found similar functional results in the coloplasty group compared to the J-pouch group. The neorectal sensitivity was increased in the coloplasty group. Therefore, the colonic coloplasty seems to be an attractive pouch design because of its feasibility, simplicity, and effectiveness.

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

“…Using the anal Scott spreading device (lone star) the anus and distal rectum are exposed, and the rectum transected proximal to the dentate line after intersphincteric dissection. The specimen can be retrieved through a small Pfannenstiel incision or through the anus, and an end-to-side or J pouch anastomosis is performed [74,85,106,107]. The presacral space should be drained and a defunctioning loop ileostomy created to protect the anastomosis [91,92].…”

“…Controversy exists about the type of anastomosis to use in low anterior resection and coloanal anastomosis: straight anastomosis, J pouch anastomosis, transverse coloplasty or end-to-side anastomosis [106][107][108][109][110][111]. One review concludes that probably end-to-side anastomosis will result in the same functional quality of life as pouch anastomosis [109].…”

Colonic Reservoirs in Patients After Rectal Resection

“…1b), a method previously coloplasty has become the frequently used method of choice for forming a fecal reservoir. There are no major differences found with respect to evaluation of the functional outcomes following JP or CP, but the coloplasty technique appears to be simpler and is associated with a lower risk of postoperative complications (38,39,40,44,49).…”

“…According to Fazio et al (41), the colon should be incised longitudinally between the teniae with a length of 8-10 cm and at a distance of 4 cm from the planned line of anastomosis, with the opening sutured in a transverse fashion. Other authors recommend decreasing the distance from the line of anastomosis from 4 to 3 or even 2 cm and making the incision of the intestine with a length of about 5 cm (38,45,46). The opening may allow for introduction of the stapler to the region of anastomosis, as is the case with the opening of the flexed JP loop or the distal opening of the colon brought down to the pelvis during the procedure of its sideto-end colo-anal anastomosis (47).…”

“…According to many authors, in obese patients with a long and narrow pelvis and a relatively thickened sphincter apparatus, manoeuvres with the JP with abundant mass of the mesentery may increase the risk of complications, and, in 25% of the patients, conditions make JP formation impossible. Safe anastomosis without tension in the suture line is sometimes impossible to achieve due to insufficient length of the intestinal loop (38,39,40). For this reason, Fazio et al suggested the use of coloplasty (CP) as a method to create a fecal reservoir (fig.…”