Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma

Sphincter-saving operations are now generally accepted for the treatment of mid-rectal cancers. Many techniques have been described: low colorectal anastomosis, pull-through procedures, and colo-anal anastomosis. The functional results following these operations are impaired by loss of the reservoir function of the rectum. In order to improve these results, a modification of Parks' colo-anal anastomosis is proposed. A J-shaped colic reservoir is constructed and its end is anastomosed to the anal canal. We have operated upon 31 patients using this technique. Mortality was 3.3 per cent. Functional results were evaluated in 24 patients having a follow-up of more than 3 months. All were continent; mean number of bowel movements was 1.1 per day. Defaecation was spontaneous in 75 per cent of cases; in the remaining 25 per cent, evacuation of the reservoir was elicited by a small enema each two days. This technique, creating a neo-rectum, can achieve an important place among the sphincter-saving operations.