Colonic J-pouch rectal reconstruction—Is it really a neorectum?

Abstract

The aim of this study was to determine whether a colonic J-pouch has similar properties to that of a normal rectum, including recovery of rectoanal coordination. Ten patients with colonic J-pouch-anal anastomosis (anastomotic distance from anal verge, 3.5 (range, 2.0-4.5) cm for low rectal cancer (7 men; mean age, 64.7 (range, 44-76) years) were studied clinically and in the anorectal physiology laboratory at least one year after operation. Results were compared with a series of ten matched patients who underwent high anterior resection for upper rectal carcinoma (anastomotic height, 12.7 (range, 9.5-16) cm). Although results seemed to be slightly better in the group with the rectum preserved, no statistical differences could be found either in functional outcome or anorectal physiology. One-half of the patients with colonic J-pouch (neorectum) had a positive rectoanal inhibitory reflex. Addition of a colon pouch neorectum would appear to improve function to the level of those patients with a high anastomosis and "normal" rectum.