Colonic JPouch

The use of a colonic J-pouch following AR was first reported in 1986, when Lazorthes and Parc, simultaneously, described a two-limbed reservoir fashioned from the terminal part of the colon as a J-construc-tion, anastomosed side-to-end to the anus (Fig. 1). This procedure was shown to reduce the dysfunctions associated with low straight anastomosis, especially in terms of stool frequency, by increasing neo-rectal volume [24, 25]. Since then, the use of colonic

Fig. 1. Small colonic J-pouch of 5-6 cm reservoirs has been accepted, becoming more and more popular.

Many retrospective studies have shown that the use of the colonic J-pouch is compatible with curative surgery and that the functional superiority of the colonic J-pouch over the straight colo-anal anastomosis is without doubt. All the existing data confirm a functional post-operative improvement after this reconstruction in terms of decrease in the number of bowel movements per day, less urgency in evacuation and, probably, better continence. These studies have provided strong evidence that these patients may not only expect better functional results, but also an improved quality of life in the early months after surgery compared with patients receiving a conventional colo-anal anastomosis. Recent randomised prospective studies confirmed these advantages, especially in the early post-operative period [26-51]. For these reasons, the role of the colonic J-pouch reconstruction in optimising the post-operative outcome of patients after total rectal resection is now widely accepted and it is universally established that J-pouch colic reconstruction is strongly indicated in anastomosis under 4 cm from the anal verge and advisable whenever the anastomosis lies under 8 cm [47-50].

Nonetheless, colonic J-pouches are still not universally used routinely after AR, mainly because there are still several areas of controversy about long-term functional outcome, technical details and functional principles of this reconstruction. In the following paragraphs the data provided in the international literature will be discussed.

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