The transverse coloplasty pouch. Review of experimental data and clinical application
Summary
The transverse coloplasty pouch is a novel technique for sphincter preserving colonic
reconstruction after total mesorectal excision. The method was developed in an animal
model and resulted in favorable early functional results. Our results in patients
with rectal cancer demonstrate that the technique is technically easy and safe. The
transverse coloplasty pouch provides a neorectal reservoir of adequate volume and
a favorable early functional outcome. It leads to a reduction in stool frequency compared
with a straight anastomosis and the outcome is comparable to other colon reservoirs.
Zusammenfassung
Der transverse Koloplastikpouch ist eine neuartige Methode der sphinktererhaltenden
Rekonstruktion nach Total Mesorektaler Exzision. Die Methode wurde zuerst im Tiermodell
entwickelt und erzielte funktionell gute Resultate. Die bisherigen Resultate beim
Menschen zeigen, dass der transverse Koloplastikpouch technisch einfach und sicher
anzuwenden ist. Sowohl frühfunktionell, wie auch im mittelfristigen Verlauf bis ein
Jahr postoperativ ergeben sich günstige Resultate mit einer Reduktion der Stuhlfrequenz
im Vergleich zur geraden Anastomose ohne Reservoirbildung. Aufgrund unserer Erfahrung
sind die funktionellen Resultate vergleichbar mit denjenigen nach Kolon J-Reservoir.
Key words
Transverse coloplasty - colon pouch - rectal cancer - sphincter preservation - total
mesorectal excision
Schlüsselwörter
Transverse Koloplastik - Kolonpouch - Rektumkarzinom - Kontinenzerhaltung - Total
Mesorektale Exzision
Literatur
1 Büchler M W, Heald R J, Maurer C A, Ulrich B. Rektumkarzinom: Das Konzept der totalen
mesorektalen Exzision. Karger, Basel, Freiburg, Paris 1998
2
Dennett E R, Parry B R.
Misconceptions about the colonic J-pouch: what the accumulating data show.
Dis Colon Rectum.
1999;
42
804-811
3
Duthie H L.
Dynamics of the rectum and anus.
Clin Gastroenterol.
1975;
4
467-477
4
Hallbook O, Pahlman L, Krog M, Wexner S D, Sjodahl R.
Randomized comparison of straight and colonic J pouch anastomosis after low anterior
resection.
Ann Surg.
1996;
224
58-65
5
Hallbook O, Sjodahl R.
Comparison between the colonic J pouch-anal anastomosis and healthy rectum: clinical
and physiological function.
Br J Surg.
1997;
84
1437-1441
6
Hida J, Yasutomi M, Fujimoto K. et al .
Functional outcome after low anterior resection with low anastomosis for rectal cancer
using the colonic J-pouch. Prospective randomized study for determination of optimum
pouch size.
Dis Colon Rectum.
1996;
39
986-991
7
Hida J, Yasutomi M, Maruyama T. et al .
Indications for colonic J-pouch reconstruction after anterior resection for rectal
cancer: determining the optimum level of anastomosis.
Dis Colon Rectum.
1998;
41
558-563
8
Lazorthes F, Gamagami R, Chiotasso P, Istvan G, Muhammad S.
Prospective, randomized study comparing clinical results between small and large colonic
J-pouch following coloanal anastomosis.
Dis Colon Rectum.
1997;
40
1409-1413
9
Maurer C A, Z'graggen K, Zimmermann W, Häni H J, Mettler D, Büchler M W.
A transverse coloplasty pouch improves the neorectal physiology: a controlled trial
in pigs.
Br J Surg.
1999;
86
1451-1458
10
Seow-Choen E.
Colonic pouches in the treatment of low rectal cancer.
Br J Surg.
1996;
83
881-882
11
Z'graggen K, Maurer C A, Mettler D, Stoupis C, Wildi S, Büchler M W.
A novel colon pouch and its comparison with a straight coloanal and colon J-pouch-anal
anastomosis: Preliminary results in pigs.
Surgery.
1999;
125
105-112
12
Z'graggen K, Maurer C A, Büchler M W.
Transverse coloplasty pouch: A novel neorectal reservoir.
Dig Surg.
1999;
16
363-366
13 Z'graggen K, Maurer C A, Birrer S, Giachino D, Kern B, Renzulli P, Büchler M W.
A new surgical concept for rectal replacement after low anterior resection: The transverse
coloplasty pouch. 2001 submitted
Priv.-Doz. Dr. Kaspar Z'graggen
Klinik für Viszerale und Transplantationschirurgie Universität Bern Inselspital
CH-3010 Bern
Phone: 00 41/31/6 32 85 15
Fax: 00 41/31/6 32 83 34
Email: kaspar.zgraggen@insel.ch