Colonic JPouch in Elderly People

In the elderly, fear of poor function reduces the indication for AR in favour of abdominoperineal excision or Hartmann's procedure. The analysis of literature data shows that functional outcome after colonic J-pouch reconstruction is similar in patients older and younger than 75, that the bowel function is comparable in both groups and also that continence is good [17,48,63]. These results suggest that the creation of a reservoir is appropriate for elderly patients and, if there are no pre-operative continence problems, it is unjustifiable not to restore bowel continuity.

In spite of these reports, however, the colonic J-pouch did not find widespread use except in specialised colorectal units. Many surgeons are not trained in this technique and prefer a straight colo-anal anastomosis, considering the J-pouch reconstruction a complication of AR operation. The failure rate in performing a planned colic pouch is about 26% [64]. The reasons for failure can be divided into two groups: in the first one (86%) are included all technical or anatomic difficulties linked to pouch construction or anastomosis (pelvis too narrow 43%, bulky anal sphincter 33%, extensive diverticular disease 11% and insufficient length of the colon 7%). The second group (14%) contains the relative failures that can follow the surgeon's decision to keep the operation as quick and as simple as possible and perform a straight anastomosis as a consequence of the case complexity (7%) or of the degree of tumour dissemination (7%) [30, 64]. The improvement of this failure rate is the future aim and should stimulate the development of alternative techniques.

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