Transverse coloplasty pouch and colonic J‐pouch for rectal cancer – a comparative study

Abstract

Objectives The introduction of the colonic J-pouch has markedly improved the functional outcome of restorative rectal cancer surgery. However colonic J-pouch surgery can be problematic and may present some late evacuatory problems. To overcome these limitations a novel pouch has been proposed: the transverse coloplasty pouch. The purpose of our study was to compare the functional outcomes of these two different types of pouches -the transverse coloplasty pouch (TCP) and the colonic J-pouch (CJP) -during the first 12 months postoperatively.Patients and methods A prospective randomized trial was conducted in which a total of 30 patients with mid and low rectal cancer were submitted either to a transverse coloplasty pouch or a colonic J-pouch. Clinical defaecatory function was assessed and anorectal physiological assessment was carried out, pre-operatively and at 3, 6 and 12 months postoperatively, by means of a standard clinical questionnaire and by anorectal manometry.Results No statistically significant differences were found between the two groups regarding bowel function. The postoperative frequency of daily bowel movements was lower in the TCP group in all the phases of the study (3.9 vs. 4.1 at 3 months; 3.1 vs. 3.4 at 6 months; 2.1 vs. 2.8 at 12 months), the same occurring with fragmentation (33% vs. 40% at 3 months; 26.6% vs. 33.3% at 6 months; 7.1% vs. 14.3% at 12 months). Less urgency was also seen in the TCP group during the first 6 months (20% vs. 26.7%), with identical values at 12 months (14.3% vs. 14.3%). No significant differences were also found concerning incontinence grading and scoring, with TCP patients having less nocturnal leaks. At one year two CJP patients (14.3%) needs the use of enemas to evacuate the pouch and provoke defaecation, a problem never seen in TCP patients. The anorectal manometry data was similar in both types of pouches. The local complication rates were also identical in the two groups (20%); more anastomotic leaks were seen in TCP patients (13.2% vs. 6.6%), without reaching a statistical significance. ConclusionThe transverse coloplasty pouch has similar functional results but fewer evacuation problems than the J-Pouch, making it a safe and reliable alternative to the colonic J-pouch.

A Randomized Multicenter Trial to Compare Long-Term Functional Outcome, Quality of Life, and Complications of Surgical Procedures for Low Rectal Cancers

“…The exit conduit from the coloplasty reservoir could fit/traverse the anal sphincters as far as an SA can. When the coloplasty pouch was compared with the JP in some randomized, controlled trials (RCT), and limited RCT, it showed results comparable to the JP 21,22 and superior to the SA. 23 However, no randomized trial has prospectively compared the functional outcome of all 3 procedures.…”

Causes and Prevention of Functional Disturbances Following Low Anterior Resection for Rectal Cancer

“…It is easier to make and can be located in the pelvic floor even when there is a lot of fatty tissue in the mesocolon. In randomized studies (29,33,58,131 comparing coloplasty with the colon J pouch, no difference was found in the frequency of bowel movement in the early post-operative phase up to eight months, and the same result was seen in three studies up to 18 and 24 months respectively after surgery. In one of the studies (58) an advantage was seen with the colon J pouch with regard to imperative urge to defecate up to eight months post-operatively, however not after a longer period (29,33,131).…”

“…In randomized studies (29,33,58,131 comparing coloplasty with the colon J pouch, no difference was found in the frequency of bowel movement in the early post-operative phase up to eight months, and the same result was seen in three studies up to 18 and 24 months respectively after surgery. In one of the studies (58) an advantage was seen with the colon J pouch with regard to imperative urge to defecate up to eight months post-operatively, however not after a longer period (29,33,131). In the studies the continence scores and use of antidiarrheals did not differ in the early post-operative period (29,33,58,131), nor in two studies covering a longer period after surgery (29,33,131).…”

“…In one of the studies (58) an advantage was seen with the colon J pouch with regard to imperative urge to defecate up to eight months post-operatively, however not after a longer period (29,33,131). In the studies the continence scores and use of antidiarrheals did not differ in the early post-operative period (29,33,58,131), nor in two studies covering a longer period after surgery (29,33,131). In a meta-analysis no differences were found in the SF or in the manometric and volumetric parameters (93).…”

Surgical correction of functional disorders in performing sphincterosafing operations for rectal cancer (literature review)

“…Brown, he had the following advantages: compactness, ease of sending down in conditions of small pelvis and in patients with a short mesentery of the colon [30]. However, according to most studies, there was statistically significant differences in functional performance compared with "J" reservoir [38,39].…”