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J.Jpn. Surg. Soc.. 109(5): 274-277, 2008


Feature topic

RECONSTRUCTION METHODS TO ACHIEVE OPTIMAL POSTOPERATIVE BOWEL FUNCTION FOLLOWING LOW ANTERIOR RESECTION FOR RECTAL CANCER

Department of Surgery, Teikyo University Chiba Medical Center, Japan

Keiji Koda, Hideki Yasuda, Masato Suzuki, Masato Yamazaki, Tohru Tezuka, Chihiro Kosugi, Ryota Higuchi, Maki Sugimoto, Atsushi Hirano, Shuichiro Uemura, Hironori Tsuchiya

After low anterior resection for rectal cancer, approximately 50% of patients experience defecatory malfunction such as multiple evacuations, urgency, and soiling. Since the neorectum is constructed with the remaining colonic segment, it can only substitute for the rectum to a limited extent. A straight anastomosis is most frequently used when the rectal remnant is sufficient, such as in high anterior resection. When the height of anastomosis is close to the anal sphincter, a J-pouch, a side-to-end, or a transverse coloplasty pouch are constructed to achieve better postoperative bowel function. The advantage of J-pouch reconstruction is not only the increased volume but also may be decreased motility when compared with straight reconstruction. In terms of postoperative function, the side-to-end and transverse coloplasty pouch have both been reported to exhibit similar functional results to J-pouch reconstruction. To obtain optimal functional results, pouch reconstruction should be considered, especially when the height of anastomosis is at the levator plane.


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