Side-to-end vs. Colonic Pouch vs. End-to-end Anastomosis in Low Anterior Resection

Abstract

Poor bowel function may occur after low anterior resection (LAR) with a straight anastomosis. The use of the colonic J-pouch is becoming increasingly popular in reconstruction to reduce these symptoms. An alternative method is to use a side-to-end anastomosis. The present study compared the functional results after LAR among patients receiving a side-to-end, colonic J-pouch, or end-to-end anastomosis. Seventeen patients underwent side-to-end anastomosis. Postoperative manometric and functional assessments of these patients were compared with a group of 19 patients who had a colonic J-pouch and low colorectal anastomosis and 13 patients who had an end-to-end anastomosis. There were no significant differences in maximum resting pressure and maximum squeeze pressure among the groups. Maximum tolerable volume was significantly favorable in the side-to-end group and colonic J-pouch group vs. the end-to-end group. Urgency of defecation was significantly greater in the end-to-end group than in the other two groups at three months postoperatively. There were no significant differences in functional and manometric results between the side-to-end and colonic J-pouch groups. Functional results of side-to-end anastomosis were comparable with colonic J-pouch and were superior to those of end-to-end anastomosis in the immediate postoperative period.