In 1986 a colonic J-pouch was described by Parc et al.  and by Lazorthes et al. , independently, to replace the excised rectal reservoir. The procedure comprises of identification of limbs with closed distal colon and seromuscular apposition. Long coloto-my, closure of posterior and anterior wall may be performed using either conventional continuous suturing or a GIA stapling device with the final attachment colonic pouch to the anus with circular stapler. Ideal pouch dimensions are 6-7 cm of bowel circumference and with limb lengths about 5 cm. Most surgeons are of the crucial step of the procedure is mobilization of the splenic flexure of the colon and preserving the first branch of the inferior mesenteric artery to enable blood perfusion through the pouch . Patients with colonic J-pouch may experience varying degrees of incomplete defecation requiring provoked evacuation with laxatives or daily enema use, unless J-pouch limbs are limited to a 5 cm size .
Inability to perform colonic J-pouch arises from some technical reasons, and therefore in about 25% of patients are unable to have a colonic J-pouch. Difficulties in creating a colonic J-pouch include:
• narrow pelvis (especially male patients)
• bulky colonic pouch
• long anal canal with prominent sphincters
• short fatty mesocolon
• insufficient colon length.
Benefits of colonic J-pouch are better rectal compliance and higher maximal tolerable rectal volume which can lead to improved rectal function after LAR [32, 33].
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