[Restorative proctectomy. A comparison of direct colo-anal and colon-pouch-anal anastomoses for reconstructing...

Thirty-nine of 63 patients undergoing deep anterior rectal resection received a straight coloanal anastomosis (CAA); the remaining 24 patients additionally had a colon-j-pouch (CPA) constructed. After pouch-anal anastomosis, local septic complications occurred in 12.5% of patients compared to 20.5% after coloanal anastomosis. Stool frequency after pouch-anal anastomosis was 3.3 per 24 h compared to 5.2 per 24 h after straight anastomosis within the first year after ileostomy closure (P = 0.053). Continence was slightly better in the pouch group (n.s.), and anal manometry showed a significant postoperative decrease only in resting pressure after straight colonal anastomosis (P < 0.001). This study supports the construction of a colon-j-pouch after deep rectal resection, as the pouch-anal anastomosis has fewer local septic complications and seems to improve functional outcome.