Preservation of rectal function after low anterior resection with formation of a neorectum

Abstract

Recent advances in surgery have enabled low rectal cancers to be resected, while at the same time restoring bowel continuity and preserving the anal sphincter. Although a permanent stoma is avoided and the operation is oncologically sound, function may be compromised. Many patients with a straight coloanal anstomosis suffer from urgency, incontinence, and bowel frequency—the so‐called anterior resection syndrome. Over the last 15 years, surgical developments have aimed at improving function after restoration of bowel continuity, essentially by creating a neorectum. The best known and most widely practiced operation involves formation of a colonic J‐pouch. The physiological and functional outcomes of the colonic J‐pouch are discussed, along with controversies surrounding construction. Although a J‐pouch improves some aspects of function, the results are not perfect. Alternatives to the colonic J‐pouch are appraised, indicating future areas of development. Semin. Surg. Oncol. 19:376–385, 2000.