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Title: Restoration of bowel continuity after low anterior rectal cancer resection with a transverse coloplasty pouch: initial clinical findings

Bartłomiej Szynglarewicz, Rafał Matkowski, Józef Forgacz, Marek Pudełko, Jan Kornafel
Original articles
Polish Gastroenterology
Start page:
Final page:
rectal cancer, low anterior resection, transverse coloplasty pouch

Introduction: The functional superiority of a colon J-pouch over a straight coloanal anastomosis after sphincter-saving low rectal resection has been confirmed in randomised controlled trials and is now rather undisputed. However, it can be technically difficult to create in patients with a short colon, bulky mesentery, or narrow pelvis. Furthermore, problems with stool evacuation are common. Aim of the study: To assess the feasibility, safety, and short-term clinical outcomes of a pouch constructed by transverse coloplasty. Material and methods: A prospective analysis of an initial series of 32 patients with primary resectable low rectal cancer (?7 cm from the anal verge) was done. All patients underwent low anterior resection with total mesorectal excision without preoperative radiation. Bowel continuity was reconstructed with a tension-free anastomosis using a small-volume reservoir created by transverse coloplasty. In 18 elderly (over 70 years old) or obese (body mass index over 30) patients and those with significant concomitant diseases, proximal diversion was done for 3 months. None of the patients were incontinent before surgery. Results: There was no postoperative mortality. The transverse coloplasty pouch was constructed without difficulty or any intraoperative complications. Mean time of pouch formation was 12 min (range 6-20). Neither pelvic abscess nor anastomotic leakage occurred. After 6 months, persistent stool incontinence or urgency was noted in 6 patients (19%). In all of them, resection was followed by adjuvant chemoradiotherapy. Pouch evacuation problems were not observed. The mean frequency of bowel movement was 2.1 (range 1-5). Anastomosis stricture developed in one patient (3%) and was successfully managed by dilatation. Conclusions: The transverse coloplasty pouch is feasible, easy to create, and not time consuming. It seems to be a safe procedure leading to promising early functional outcomes. It can be considered an interesting option especially in cases where a J-pouch is difficult to construct. To evaluate long-term results, further studies are needed.