Whether the benefits are maintained in the long term is still being debated. The data published on the long-term results are contradictory. It is known that bowel function improves with time after a straight anastomosis, presumably as a result of a neorectal neurosen-sorial adaptation as well as of a recovery of the anal sphincter function. In some studies looking at long-term function after straight and J-pouch construction the incidence of incontinence is equal after the first post-operative year and the frequency of evacuation improves with time in both groups [51, 52]. More recent studies demonstrate, however, that the functional superiority of colonic J-pouch persists over time, even 5 years after surgery, especially in patients whose anastomosis is less than 4 cm from the anal verge [53, 54].
Nevertheless, the superior function within the first post-operative year is clear and this alone can justify
Fig. 1. Small colonic J-pouch of 5-6 cm pouch formation instead of straight colo-anal anastomosis in patients with rectal cancer.
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