[Does colonic J-pouch after low anterior resection of rectal cancer give a better functional result?]

Low anterior resection (LAR) with mesorectal excision for adenocarcinoma of the rectum leads to low colorectal or coloanal anastomosis, and often poor functional results. Increased stool frequency and urge are common after the operation, and some have anal incontinence. Construction of a neo-rectum, in the form of a colonic J-pouch improves the functional results to some extent. Patients with a colonic J-pouch have significantly lower stool frequency and perhaps also fewer symptoms of urge and incontinence than patients with a straight coloanal anastomosis. If part of the rectum is preserved, the benefit of a pouch is doubtful. The overall quality of life after the operation in patients with a J-pouch is not different from quality of life in patients with a straight coloanal anastomosis. Patients with a pouch may have trouble emptying the reservoir, this is less pronounced if the pouch is shortened to 5 cm. It is not proved with certainty that patients with a colonic J-pouch have fewer anastomotic leakages than patients with a straight coloanal anastomosis. It is concluded that with an anastomotic height below 5 cm a pouch apparently improves the functional results after LAR for adenocarcinoma of the rectum, while the benefit of a pouch above this anastomotic height is doubtful.