Download PDF
Clin Colon Rectal Surg 2007; 20(3): 221-230
DOI: 10.1055/s-2007-984866
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Reconstruction Techniques after Proctectomy: What's the Best?

Sebastian G. de la Fuente1 , Christopher R. Mantyh1
  • 1Division of Colorectal Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
Further Information

Publication History

Publication Date:
31 July 2007 (online)

Also available at
   Permissions and Reprints

ABSTRACT

There are ~40,000 new rectal cancer cases diagnosed each year in the United States, representing the second most common gastrointestinal malignancy (behind colon cancer). With the advent of sphincter preserving techniques, patients with mid and low colorectal cancers enjoy the benefits of better postoperative functional outcomes and quality of life; however, controversy exists over which reconstructive technique is superior in restoring bowel continuity. Construction of a straight coloanal anastomosis is technically simpler, but functional outcomes are inferior compared with colonic reservoirs. The purpose of this review is to summarize the current data regarding reconstructive techniques following proctectomy.

KEYWORDS

Rectal neoplasms - colonic pouches - proctocolectomy - restorative - anastomosis - surgical

REFERENCES

  • 1 American Cancer Society .Cancer Facts and Figures 2006. Atlanta, GA; American Cancer Society 2006 Available at: http://www.cancer.org/downloads/STT/CAFF2006PWSecured.pdf Accessed January 11, 2006
    Search in Google Scholar
  • 2 Bernold D M, Sinicrope F A. Advances in chemotherapy for colorectal cancer.  Clin Gastroenterol Hepatol. 2006;  4 808-821
    CrossrefPubMedSearch in Google Scholar
  • 3 Ortholan C, Francois E, Thomas O et al.. Role of radiotherapy with surgery for T3 and resectable T4 rectal cancer: evidence from randomized trials.  Dis Colon Rectum. 2006;  49 302-310
    CrossrefPubMedSearch in Google Scholar
  • 4 Chessin D B, Guillem J G. Surgical issues in rectal cancer: a 2004 update.  Clin Colorectal Cancer. 2004;  4 233-240
    PubMedSearch in Google Scholar
  • 5 McNamara D A, Parc R. Methods and results of sphincter-preserving surgery for rectal cancer.  Cancer Control. 2003;  10 212-218
    PubMedSearch in Google Scholar
  • 6 Williams N, Seow-Choen F. Physiological and functional outcome following ultra-low anterior resection with colon pouch-anal anastomosis.  Br J Surg. 1998;  85 1029-1035
    CrossrefPubMedSearch in Google Scholar
  • 7 Chew S B, Tindal D S. Colonic J-pouch as a neorectum: functional assessment.  Aust N Z J Surg. 1997;  67 607-610
    PubMedSearch in Google Scholar
  • 8 Harris G J, Lavery I J, Fazio V W. Reasons for failure to construct the colonic J-pouch. What can be done to improve the size of the neorectal reservoir should it occur?.  Dis Colon Rectum. 2002;  45 1304-1308
    CrossrefPubMedSearch in Google Scholar
  • 9 Z'graggen K, Maurer C A, Birrer S, Giachino D, Kern B, Buchler M W. A new surgical concept for rectal replacement after low anterior resection: the transverse coloplasty pouch.  Ann Surg. 2001;  234 780-785
    CrossrefPubMedSearch in Google Scholar
  • 10 Lazorthes F, Chiotasso P, Gamagami R A, Istvan G, Chevreau P. Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis.  Br J Surg. 1997;  84 1449-1451
    CrossrefPubMedSearch in Google Scholar
  • 11 Barrier A, Martel P, Gallot D, Dugue L, Sezeur A, Malafosse M. Long-term functional results of colonic J pouch versus straight coloanal anastomosis.  Br J Surg. 1999;  86 1176-1179
    CrossrefPubMedSearch in Google Scholar
  • 12 Ulrich A, Z'graggen K, Schmitz-Winnenthal H, Weitz J, Buchler M W. The transverse coloplasty pouch.  Langenbecks Arch Surg. 2005;  390 355-360
    CrossrefPubMedSearch in Google Scholar
  • 13 McGinn F P, Gartell P C, Clifford P C, Brunton F J. Staples or sutures for low colorectal anastomoses: a prospective randomized trial.  Br J Surg. 1985;  72 603-605
    PubMedSearch in Google Scholar
  • 14 Everett W G, Friend P J, Forty J. Comparison of stapling and hand-suture for left-sided large bowel anastomosis.  Br J Surg. 1986;  73 345-348
    CrossrefPubMedSearch in Google Scholar
  • 15 West of Scotland and Highland Anastomosis Study Group . Suturing or stapling in gastrointestinal surgery: a prospective randomized study.  Br J Surg. 1991;  78 337-341
    PubMedSearch in Google Scholar
  • 16 Docherty J G, McGregor J R, Akyol A M, Murray G D, Galloway D J. Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group.  Ann Surg. 1995;  221 176-184
    PubMedSearch in Google Scholar
  • 17 MacRae H M, McLeod R S. Handsewn vs. stapled anastomoses in colon and rectal surgery: a meta-analysis.  Dis Colon Rectum. 1998;  41 180-189
    CrossrefPubMedSearch in Google Scholar
  • 18 Lustosa S A, Matos D, Atallah A N, Castro A A. Stapled versus handsewn methods for colorectal anastomosis surgery.  Cochrane Database of Systematic Reviews. 2001;  (3) , CD003144
    PubMedSearch in Google Scholar
  • 19 Miller K, Moritz E. Circular stapling techniques for low anterior resection of rectal carcinoma.  Hepatogastroenterology. 1996;  43 823-831
    PubMedSearch in Google Scholar
  • 20 Vignali A, Fazio V W, Lavery I C et al.. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients.  J Am Coll Surg. 1997;  185 105-113
    CrossrefPubMedSearch in Google Scholar
  • 21 Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum.  Colorectal Dis. 2004;  6 462-469
    CrossrefPubMedSearch in Google Scholar
  • 22 Konishi T, Watanabe T, Kishimoto J, Nagawa H. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance.  J Am Coll Surg. 2006;  202 439-444
    CrossrefPubMedSearch in Google Scholar
  • 23 Beard J D, Nicholson M L, Sayers R D, Lloyd D, Everson N W. Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial.  Br J Surg. 1990;  77 1095-1097
    CrossrefPubMedSearch in Google Scholar
  • 24 Davies A H, Bartolo D C, Richards A E, Johnson C D, McC Mortensen N J. Intra-operative air testing: an audit on rectal anastomosis.  Ann R Coll Surg Engl. 1988;  70 345-347
    PubMedSearch in Google Scholar
  • 25 Karanjia N D, Corder A P, Holdsworth P J, Heald R J. Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis.  Br J Surg. 1991;  78 196-198
    CrossrefPubMedSearch in Google Scholar
  • 26 Dehni N, Schlegel R D, Cunningham C, Guiguet M, Tiret E, Parc R. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis.  Br J Surg. 1998;  85 1114-1117
    CrossrefPubMedSearch in Google Scholar
  • 27 Giuliani D, Willemsen P, Van Elst F, Vanderveken M. A defunctioning stoma in the treatment of lower third rectal carcinoma.  Acta Chir Belg. 2006;  106 40-43
    PubMedSearch in Google Scholar
  • 28 Machado M, Hallbook O, Goldman S, Nystrom P O, Jarhult J, Sjodahl R. Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer: a comparison between two hospitals with a different policy.  Dis Colon Rectum. 2002;  45 940-945
    CrossrefPubMedSearch in Google Scholar
  • 29 Mealy K, Burke P, Hyland J. Anterior resection without a defunctioning colostomy: questions of safety.  Br J Surg. 1992;  79 305-307
    PubMedSearch in Google Scholar
  • 30 Pakkastie T E, Ovaska J T, Pekkala E S, Luukkonen P E, Jarvinen H J. A randomised study of colostomies in low colorectal anastomoses.  Eur J Surg. 1997;  163 929-933
    PubMedSearch in Google Scholar
  • 31 Graffner H, Fredlund P, Olsson S A, Oscarson J, Petersson B G. Protective colostomy in low anterior resection of the rectum using the EEA stapling instrument. A randomized study.  Dis Colon Rectum. 1983;  26 87-90
    PubMedSearch in Google Scholar
  • 32 Wong N Y, Eu K W. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study.  Dis Colon Rectum. 2005;  48 2076-2079
    CrossrefPubMedSearch in Google Scholar
  • 33 Grabham J A, Moran B J, Lane R H. Defunctioning colostomy for low anterior resection: a selective approach.  Br J Surg. 1995;  82 1331-1332
    PubMedSearch in Google Scholar
  • 34 Rullier E, Laurent C, Garrelon J L, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer.  Br J Surg. 1998;  85 355-358
    CrossrefPubMedSearch in Google Scholar
  • 35 Koperna T. Cost-effectiveness of defunctioning stomas in low anterior resections for rectal cancer: a call for benchmarking.  Arch Surg. 2003;  138 1334-1338
    PubMedSearch in Google Scholar
  • 36 Nathanson D R, Espat N J, Nash G M et al.. Evaluation of preoperative and postoperative radiotherapy on long-term functional results of straight coloanal anastomosis.  Dis Colon Rectum. 2003;  46 888-894
    CrossrefPubMedSearch in Google Scholar
  • 37 Joo J S, Latulippe J F, Alabaz O, Weiss E G, Nogueras J J, Wexner S D. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of the colonic J-pouch sustained?.  Dis Colon Rectum. 1998;  41 740-746
    PubMedSearch in Google Scholar
  • 38 Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum.  Br J Surg. 1986;  73 136-138
    CrossrefPubMedSearch in Google Scholar
  • 39 Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J. Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma.  Br J Surg. 1986;  73 139-141
    PubMedSearch in Google Scholar
  • 40 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
    PubMedSearch in Google Scholar
  • 41 Seow-Choen F, Goh H S. Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction.  Br J Surg. 1995;  82 608-610
    CrossrefPubMedSearch in Google Scholar
  • 42 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
    CrossrefPubMedSearch in Google Scholar
  • 43 Banerjee A K, Parc R. Prediction of optimum dimensions of colonic pouch reservoir.  Dis Colon Rectum. 1996;  39 1293-1295
    CrossrefPubMedSearch in Google Scholar
  • 44 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
    PubMedSearch in Google Scholar
  • 45 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
    CrossrefPubMedSearch in Google Scholar
  • 46 Hida J, Yasutomi M, Maruyama T, Tokoro T, Wakano T, Uchida T. Enlargement of colonic pouch after proctectomy and coloanal anastomosis: potential cause for evacuation difficulty.  Dis Colon Rectum. 1999;  42 1181-1188
    PubMedSearch in Google Scholar
  • 47 Amin A I, Hallbook O, Lee A J, Sexton R, Moran B J, Heald R J. 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.  Colorectal Dis. 2003;  5 33-37
    CrossrefPubMedSearch in Google Scholar
  • 48 Braga M, Vignali A, Zuliani W et al.. Metabolic and functional results after laparoscopic colorectal surgery: a randomised, controlled trial.  Dis Colon Rectum. 2002;  45 1070-1077
    CrossrefPubMedSearch in Google Scholar
  • 49 Pikarsky A J, Rosenthal R, Weiss E G, Wexner S D. Laparoscopic total mesorectal excision.  Surg Endosc. 2002;  16 558-562
    CrossrefPubMedSearch in Google Scholar
  • 50 Breukink S, Pierie J, Wiggers T. Laparoscopic versus open total mesorectal excision for rectal cancer.  Cochrane Database Syst Rev. 2006;  4 CD005200
    PubMedSearch in Google Scholar
  • 51 Chung C C, Ha J P, Tsang W W, Li M K. Laparoscopic-assisted total mesorectal excision and colonic J pouch reconstruction in the treatment of rectal cancer.  Surg Endosc. 2001;  15 1098-1101
    CrossrefPubMedSearch in Google Scholar
  • 52 Tsang W W, Chung C C, Kwok S Y, Li M K. Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results.  Ann Surg. 2006;  243 353-358
    CrossrefPubMedSearch in Google Scholar
  • 53 Heriot A G, Tekkis P P, Constantinides V et al.. Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection.  Br J Surg. 2006;  93 19-32
    CrossrefPubMedSearch in Google Scholar
  • 54 Koh P K, Tang C L, Eu K W, Samuel M, Chan E. A systematic review of the function and complications of colonic pouches.  Int J Colorectal Dis. 2007;  22(5) 543-548
    CrossrefPubMedSearch in Google Scholar
  • 55 Sailer M, Fuchs K H, Fein M, Thiede A. Randomized clinical trial comparing quality of life after straight and pouch coloanal reconstruction.  Br J Surg. 2002;  89 1108-1117
    CrossrefPubMedSearch in Google Scholar
  • 56 Ho Y H, Seow-Choen F, Tan M. Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized controlled trial.  World J Surg. 2001;  25 876-881
    CrossrefPubMedSearch in Google Scholar
  • 57 Ho Y H, Brown S, Heah S M et al.. Comparison of J-pouch and coloplasty pouch for low rectal cancers; a randomized controlled trial investigating functional results and anastomotic leak rates.  Ann Surg. 2002;  236 49-55
    CrossrefPubMedSearch in Google Scholar
  • 58 Furst A, Suttner S, Agha A, Beham A, Jauch K W. Colonic J-pouch vs coloplasty following resection of distal rectal cancer: early results of a prospective, randomized, pilot study.  Dis Colon Rectum. 2003;  46 1161-1166
    CrossrefPubMedSearch in Google Scholar
  • 59 Furst A, Burghofer K, Hutzel L, Jauch K-W. Neorectal reservoir is not the functional principle of the colonic J-pouch: the volume of a short colonic J-pouch does not differ from a straight coloanal anastomosis.  Dis Colon Rectum. 2002;  45 660-667
    CrossrefPubMedSearch in Google Scholar
  • 60 Pimentel J M, Duarte A, Gregorio C, Souto P, Patricio J. Transverse coloplasty pouch and colonic J-pouch for rectal cancer - a comparative study.  Colorectal Dis. 2003;  5 465-470
    CrossrefPubMedSearch in Google Scholar
  • 61 Oya M, Komatsu J, Takase Y, Nakamura T, Ishikawa H. Comparison of defecatory function after colonic J-pouch anastomosis and straight anastomosis for stapled low anterior resection: results of a prospective randomized trial.  Surg Today. 2002;  32 104-110
    CrossrefPubMedSearch in Google Scholar
  • 62 Z'graggen K, Maurer C A, Mettler D, Stoupis C, Wildi S, Buchler 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
    CrossrefPubMedSearch in Google Scholar
  • 63 Fazio V W, Mantyh C R, Hull T L. Colonic “coloplasty”: novel technique to enhance low colorectal or coloanal anastomosis.  Dis Colon Rectum. 2000;  43 1448-1450
    PubMedSearch in Google Scholar
  • 64 Mantyh C R, Hull T L, Fazio V W. Coloplasty in low colorectal anastomosis: manometric and functional comparison with straight and colonic J-pouch anastomosis.  Dis Colon Rectum. 2001;  44 37-42
    PubMedSearch in Google Scholar
  • 65 Ulrich A, Z'graggen K, Weitz J, Buchler M W. Functional results of the colon J-pouch versus transverse coloplasty pouch in Heidelberg.  Recent Results Cancer Res. 2005;  165 205-211
    PubMedSearch in Google Scholar
  • 66 Maurer C A, Z'graggen K, Zimmermann W, Hani H J, Mettler D, Buchler M W. Experimental study of neorectal physiology after formation of a transverse coloplasty pouch.  Br J Surg. 1999;  86 1451-1458
    CrossrefPubMedSearch in Google Scholar
  • 67 Kanne V, Kim N H, Ulrich B. The Transverse Coloplasty Pouch (TCP)-function and subjective judgement in comparison with the surgically more complicated J-Pouch.  Zentralbl Chir. 2002;  127 781-785
    PubMedSearch in Google Scholar
  • 68 Brown C J, Fenech D S, McLeod R S. Straight coloanal anastomosis, colonic J pouch or transverse coloplasty for reconstruction after rectal resection for rectal cancer.  Cochrane Colorectal Cancer Group Cochrane Database of Systematic Reviews. 2007;  (2) , CD006040
    PubMedSearch in Google Scholar

Christopher R MantyhM.D. 

DUMC, P.O. Box 3117

Durham, NC 27710

Email: manty001@mc.duke.edu