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A 5‐cm colonic J pouch colo‐anal reconstruction following anterior resection for low rectal cancer results in acceptable evacuation and continence in the long term
Author(s) -
Amin A. I.,
Hallböök O.,
Lee A. J.,
Sexton R.,
Moran B. J.,
Heald R. J.
Publication year - 2003
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1046/j.1463-1318.2003.00399.x
Subject(s) - medicine , anastomosis , pouch , stoma (medicine) , total mesorectal excision , colorectal cancer , fecal incontinence , surgery , anus , defecation , colorectal surgery , cancer , abdominal surgery
Background Optimal treatment for low rectal cancer is total mesorectal excision, with most patients suitable for low colo‐rectal or colo‐anal anastomosis. A colon pouch has early functional benefits, although long‐term function, especially evacuation, might mitigate against its routine use. The aim of this study was to assess evacuation and continence in patients with a colon pouch, and to examine the impact of possible risk factors. Methods In 1998, all 102 surviving patients with a colon pouch, whose stoma had been closed for more than one year, were sent a postal questionnaire. A composite incontinence score was calculated from questions on urgency, use of a pad, incontinence of gas, liquid or faeces; and a composite evacuation score from questions on medication taken to evacuate, straining, the need and number of times returned to evacuate. Results The response rate was 90% (50 M, 42 F), with a median age of 68 years (IQR 60–78) and median follow‐up of 2.6 years (IQR 1.7–3.9). The anastomosis was 3 cm or less from the anus in 45/92 (49%), and incontinence scores were worse in this group ( P = 0.001). There were significantly higher incontinence scores in females ( P = 0.014). Age, preoperative radiotherapy, part of colon used for anastomosis, postoperative leak and length of follow‐up had no demonstrable effect on either score. Conclusion Gender and anastomotic height were the only variables which influenced incontinence. Ninety percent of patients reported that their bowel function did not affect their overall wellbeing, and none would have preferred to have a stoma.