Enlargement of colonic pouch after proctectomy and coloanal anastomosis - potential cause for evacuation difficulty

• Published in: Diseases of the colon & rectum Vol. 42; no. 9; pp. 1181 - 1188
• Main Authors: HIDA, J.-I, YASUTOMI, M, MARUYAMA, T, TOKORO, T, WAKANO, T, UCHIDA, T
• Format: Journal Article
• Language: English
• Published: Secaucus, NJ Springer 01.09.1999
• Subjects: Adult; Anal Canal - diagnostic imaging; Biological and medical sciences; Follow-Up Studies; Humans; Ileum - diagnostic imaging; Medical sciences; Proctocolectomy, Restorative; Radiography; Rectal Neoplasms - surgery; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Rectal disease; J shape; Surgical anastomosis; Surgical resection; Reservoir; Anus; Dysfunction; Surgery; Risk factor; Rectum; Digestive diseases; Intestinal disease; Colon; Defecation
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/BF02238571

Although the functional outcome after low anterior resection for rectal cancer using colonic J-pouch reconstruction is superior to that using conventional straight reconstruction, the one drawback of colonic J-pouch reconstruction is difficulty with evacuation. Recently it has been suggested that construction of a larger colonic J-pouch causes the evacuation difficulty. The purpose of this study was to elucidate the cause of evacuation difficulty with colonic J-pouch reconstruction. We compared pouchography of 26 patients with 10-cm colonic J-pouch reconstructions (10-J group) and 27 patients with 5-cm colonic J-pouch reconstructions (5-J group) at three months, one year, and two years after surgery. Functional assessments were performed one year postoperatively. Clinical function was evaluated using a questionnaire. Evacuation function was evaluated by the balloon expulsion and saline evacuation tests. The greatest width of the pouch in the 10-J group in the anteroposterior view was significantly greater than that in the 5-J group at all three measurement times (3 months, 4.9 vs. 4 cm; P = 0.0011; 1 year, 9 vs. 5.6 cm; P < 0.0001; 2 years, 9.2 vs. 5.8 cm; P < 0.0001). The value in the 10-J group at one year after surgery was 1.9 times that at three postoperative months; in the 5-J group this ratio was 1.4. There was a significant difference between these ratios (P < 0.0001). No significant difference existed between the values at two years and one year after surgery in either the 10-J or the 5-J group. An evacuation difficulty was significantly more common in the 10-J group than the 5-J group. Evacuation function in the 10-J group was significantly inferior to that in the 5-J group. The evacuation difficulty observed in patients with larger colonic J-pouch reconstructions is associated with excessive distention of the pouch occurring within one year of surgery.