The surgical practice for middle and low rectal cancer has dramatically changed over the past two decades: in most patients undergoing curative resection now the anal sphincter can be preserved with restoration of intestinal continuity, thus avoiding an abdominoperineal excision of the rectum with permanent stoma in about 90% of all rectal cancers, with the same or even better oncological results [1-5].
The development of sphincter-saving procedures, such as very low colorectal or colo-anal anastomoses, has been the consequence of both oncological and technical factors: the improved knowledge of tumour spread, the diffusion of total mesorectal excision with nerve sparing, the development of stapling devices and the impact of neoadjuvant therapy [6-14].
The major advantage of anterior resection (AR) is the avoidance of a colostomy, which means a better quality of life for the patient. On the other hand, the re-establishment of intestinal continuity often results in poor functional outcome as a consequence of an alteration in pelvic physiology. These continence disorders are called "Anterior Resection Syndrome" [15-18].
In order to obtain a decrease of these dysfunctions, techniques alternative to the traditional straight anastomosis were developed, based on the creation of a reservoir able to function as a neorec-tum.
The aim of this chapter is to analyse the reconstruction techniques with reservoir, their current understanding and to define their clinical role.
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