Sideto End Anastomosis

The method of side-to-end anastomosis of the colon and rectum has been advocated to deal with the disparity between the two lumen. To create the modality the double-stapling approach can be used. Rectal stump is closed with a linear stapler. A proximal anvil is inserted in open sigmoid or descending colon and passed through the antimesenteric colonic wall. The end of distal colon is closed and the stapling completed in the usual manner [28, 36].

Rectal reservoirs should be considered, especially for anastomosis at or below 4 cm from anal verge. Traditionally a colonic J-pouch may be constructed if technically possible. Coloplasty seems to be an attractive modality to colonic J-pouch. Complications associated with the anastomosis do not differ in both groups, however colonic J-pouch patients with handsewn anastomosis had a higher anastomotic leakage rate than the patients in the coloplasty with handsewn anastomosis group [35].

Transverse coloplasty functional results are similar to those after colonic J-pouch construction and outcomes of both reservoirs are superior to straight end-to-end anastomosis [33, 35]. Colonic J-pouch and side-to-end anastomosis give comparable functional results two years after LAR [37].

However, long-term results show that there are no functional differences between described modalities and after a two-year post-operative follow-up study, quality of life outcomes also become similar. Thus, after this period, the presence of colonic reservoirs actually does not influence bowel habits or problems associated with so-called "low resection syndrome", especially after straight anastomosis. They should be considered to diminish the functional impairment in the early post-operative period after very low rectal cancer.

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