Because of evacuation difficulties after colonic J-pouch reconstruction in spite of the size reduction, a new isoperistaltic colonic H-pouch has been tested, based on the hypothesis that the evacuation difficulties are also a consequence of the anisoperistaltic function of one limb of the J-pouch.

In this procedure, the colon is divided 8 cm proximal to distal colonic section, the distal limb is translated and a 6-cm H-pouch is fashioned with a side-to-side anastomosis. The H-pouch is then anastomosed end-to-end to the anorectal stump.

Fig. 2a-d. Transverse coloplasty pouch construction for double-stapled anastomosis: measurement of the longitudinal colo-tomy and transverse interrupted suture with seromuscular 3-0 polyglycolic acid stitches

The pilot study showed that the creation of this new pouch did not improve the functional results after colo-anal anastomosis compared with the colonic J-pouch, not even in the early post-operative period. In addition, the results did not confirm that an isoperistaltic colonic reservoir could significantly relieve the evacuation difficulties but that, on the other hand, colonic H-pouch was technically more complex to fashion [77].

In short, colonic H-pouch does not provide any benefits over colonic J-pouch and it should not be performed routinely.

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