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Chirurgia 2013 August;26(4):283-6


language: English

Functional results after TME for rectal cancer: J-pouch vs. coloplasty. A single institution prospective study

Luglio G., Sivero L., Tarquini R., D’antonio D., Quarto G., De Werra C., Giglio M., Formisano C., Bucci L.

Department of General, Geriatric, Oncologic and Advanced Technologies, Federico II University of Naples, Naples, Italy


Aim: Low anterior resection with TME (Total Mesorectal Excision) is actually considered as the gold standard technique for treatment of low rectal cancer; most patients, however, after surgery develop the “anterior resection syndrome”, characterized by high stool frequency, urgency, incontinence and soiling. It is possible to construct colonic reservoirs to reduce these symptoms and colonic J-pouch is considered the gold standard technique. Aim of this study is to compare functional results and complication rate between the colonic j-pouch and a new colonic reservoir, the “transverse coloplasty pouch”.
Methods: This is a prospective study; 30 patients have been enrolled between June 2009 to June 2010 and have been followed up for one year after surgery. Patients were diveded into two groups: 20 patients received a colonic J-pouch and 10 patients a transverse coloplasty pouch. All patients received neoadjuvant chemoradiation therapy. Twelve months after surgery clinical parameters (stool frequency, fecal leakage, urgency, incontinence, incomplete emptying) and manometric parameters ( rest pressure, squeeze pressure, max tolerated volume, compliance) were compared. Results were analyzed with T-student and F Test (Snedecor’s distribution).
Results: Twelve months after surgery we did not found statistically significant differences between the two techniques, regarding clinical and functional results. In the coloplasty group, however, we had two major complications: a case of recto-vaginal fistula and a case of anastomotic leakage with vescical fistula.
Conclusion: Both colonic J-pouch and coloplasty pouch can be performed in rectal cancer surgery and lead to better but similar functional results. Anyway, transverse coloplasty seems to be affected by a higher complication rate, so it should probably be considered as a second choice technique, to use in selected cases when colonic J-pouch is really technically difficult to perform.

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