Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer

被引:83
作者
Hallbook, O [1 ]
Nystrom, PO [1 ]
Sjodahl, R [1 ]
机构
[1] LINKOPING UNIV,DEPT SURG,LINKOPING,SWEDEN
关键词
low anterior resection; coloanal anastomosis; colonic pouch; anorectal physiology;
D O I
10.1007/BF02050425
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
PURPOSE: The colonic J-pouch anastomosis has been advocated to obviate urgent and frequent defecations following a sphincter-saving rectal excision. Physiologic characteristics of the colonic J-pouch were compared with those of the traditional straight anastomosis and related to clinical function. METHOD: Patients with total mesorectal excision for carcinoma were randomized to either a straight (n = 23) or a colonic pouch anastomosis (n = 23). The patients were examined before and at one year after surgery (n = 42), which included laboratory studies, and a questionnaire regarding anorectal function was completed. RESULTS: Preoperative compliance of the rectum was restored after surgery in the pouch group, 2.9 (2.2-3.4) ml/cm H2O but there n as a significant decrease after surgery in the straight anastomosis group, 2.9 (1.1-2.3) P < 0.001 (median (interquartile range)). Sphincter pressures in both groups were similar. In a multiple regression analysis, high compliance mas associated with favorable clinical function. and hypermotility of the anal canal was associated with adverse clinical function. CONCLUSIONS: Colonic pouch-anal anastomosis restores neorectal compliance, which is important for good function after low anterior resection. Presence of an unstable internal sphincter is a negative factor for clinical function in both straight and pouch anastomoses.
引用
收藏
页码:332 / 338
页数:7
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