[Reconstructive surgery after anterior resection of the rectum]

Sphincter preservation is a goal in the treatment of rectal cancer and should be considered in all patients with intact analsphincter. For tumors of the upper rectum, this is easily achieved by end-to-end decendorectostomy. Total mesorectal excision is obligatory for tumors of the mid and lower third of the rectum. Reconstruction of intestinal continuity can be achieved by colonal anastomosis, if the oncologic situation allows a sphincter-preserving procedure. Creation of a colonic J-pouch can improve functional results. This leads to a reduction of stool frequency and urgency without negative effects on continence and complication rate. The functional effects are maximal during the initial months, but are still significant up to 9 years postoperatively. The pouch should not exceed a length of 6 cm in order to prevent evacuation disorders. The transverse coloplasty pouch may allow pouch reconstruction in patients in whom this is currently impossible, but long-term follow-up is not yet available.