Colonic J pouch-anal anastomosis after rectal excision for carcinoma: functional outcome

A consecutive series of 23 patients with colonic J pouch-anal anastomosis for low rectal cancer (17 men; mean age 64.4 (range 44-76) years) was studied prospectively. The mean distance from the pouch-anal anastomosis to the anal verge was 3.5 (range 2.0-4.5) cm. During follow-up one patient died from an unrelated cause and four developed metastases, two local and two hepatic. In 19 surviving patients a mean of 7 months after ileostomy closure mean bowel frequency was 2.1 (range 1-4) per day, five patients had urgency and four had mild faecal seepage up to three times per week, and seven patients had some degree of incomplete evacuation. In 13 patients there were no manometric differences before and after surgery with respect to maximum tolerated volume or maximum resting pressure, but maximum squeeze pressure was significantly lower after surgery (mean 189 versus 132 cmH2O before and after surgery respectively, P < 0.05). Colonic pouch reconstruction should be considered as an alternative to straight coloanal anastomosis in patients undergoing very low anterior resection.