Total mesorectal excision has become the standard procedure for treatment
of low rectal cancer. Straight coloanal anastomosis after low anterior
resection results in fi-equency, urgency and other defecation disorders
that may persist for one or two years until adaptation takes place. These
functional disorders are attributed to loss of the rectal reservoir. Colonic
J-pouch could overcome these problems. However colonic J-pouch is not
always feasible to construct. Colonic "coloplasty" is a novel technique that
was introduced as an alternative neorectal reservoir that can be done after
low anterior resection. The aim of this study is to evaluate the functional
and manometric results of the new technique colonic "coloplasty" in
low anterior resection for rectal cancer. Patients and methods: fourteen
patients with low rectal cancer were subjected to total mesorectal excision
followed by coloplasty procedure.
The postoperative follow-up included anomanometric and continence
scoring.
Results: fourteen patients had coloplasty as a neorectal reservoir after
proctectomy.
Four patients had postoperative complications: one anastomotic leak.
one adhesive small bowel obstruction, one anastomotic stricture and one
prolonged urinary bladder dysfunction. The mean number of bowel movement
was 2.6 times per day. antidiarrheal medications were required in three patients. Two patients had urge incontinence and one patient had
incontinence to liquid stool and gas. Postoperative anomanometry
showed a mean resting pressure of 37.2 mmHg. a mean squeeze pressure
of 137.5 mmHg. a mean maximum tolerated volume of 120 ml and a
mean compliance of neorectal reservoir of 4.8 mmHg. The recto-anal inhibitory
reflex was preserved in 86% of cases after the operation. Conclusion:
Colonic coloplasty is a simple procedure that can be done safely as
a neorectal reservoir. It has functional results comparable to colonic dpouch
but much easier and more feasible to perform. |
