Restoration of Intestinal Continuity After Sphincter Preserving Resection

To compensate for the loss of the reservoir function, in 1986 Lazorthes et al. [8] and Parc et al. [9] presented their results with a colonic J-pouch as a neo-rectal reservoir. Since then a number of studies have been performed to assess the functional outcome of the colonic J-pouch and to compare the results with those of straight anastomoses [4, 8]. It has been shown that patients with the colonic J-pouch present a better adaptation (Figs. 5-7) and significantly better function in terms of frequency of defecation, presence of stool fragmentation, urgency, diarrhoea and incontinence [4]. It has been further demonstrated that the optimal dimensions for the colonic J-pouch are between 6 and 7 cm, with a maximum of approximately 8 cm. Smaller pouches are associated with a reduced reservoir function, whereas larger ones are associated with evacuation difficulties [10]. The incidence of symptomatic anastomotic leakage seems reduced because the colonic J-pouch has a superior blood flow at the proximal bowel end as compared to the straight colo-anal anastomosis [11]. Neither the functional superiority nor the improved safety of the colonic pouch following a colo-anal anastomosis appear to have been challenged so far, however it has been speculated that the advantage of


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Dealing With Erectile Dysfunction

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