Reasonable Bowel Frequency

It is well known that straight end-end anastomosis and thereby loosening of a reservoir may lead to frequent evacuations, especially in the first 2 years till adaptation of the "new rectum" and regaining of some reservoir capacity has occurred. Therefore construction of a colonic pouch, which should be smaller in size (5-6 cm in length) than small bowel pouches like in ulcerative colitis or familial adenomatous polyposis (FAP) surgery, has been proposed [24]. Advantages of pouches are less frequent bowel movements, decreased clustering of stools and possibly lower risk of anastomotic leakage. However, due to the especially narrow pelvis in male patients, from an anatomical point of view, a colon pouch is not always possible. In a recent study, coloplasty was recommended as it was possible in every case, compared to colon J-pouch, which could be constructed in only 75% [25]. Furthermore, it seems that besides a better rectal sensitivity, coloplasty provides similar functional results to the J-pouch [25]. Another option is a simple side-to-end anastomosis.

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