The functional results of low anterior resections: Colorectal anastomosis vs J-pouch coloanal anastomosis

Forty-nine patients have undergone low anterior resection in the period January 1992-December 1993; they have been attributed to four groups according to the level of anastomosis and length of follow-up: - group 1: 13 patients with colorectal anastomosis - CRA - > 6 cm from anal verge; - group 2: 10 patients with low colorectal anastomosis - LCRA - (follow-up < 6 months); - group 3: 12 patients with low colorectal anastomosis - LCRA - (follow-up > 6 months); - group 4: 14 patients with J-pouch coloanal anastomosis - J-CAA. The clinical results (frequency of evacuations/24 hours, degree of fecal continence) show main differences in every group. In group 2, 80% of patients refers more than 5 evacuations/24 hours and 60% complains of incontinence for liquid stools; 70% of patients reports an unsatisfactory result. In group 3, a 6 months delay from surgery is enough to produce an improved clinical result in about 2/3 of patients. The clinical results and personal judgment of groups 1 and 4 are positive since the postoperative period in all cases. Postoperative manometric measurements reveal a very low value of anal data (MBP and MSP) in relation with the clinical result; on the contrary an important significance is attributed to rectal manometric data (VIS, MVT and rectal compliance). So preoperative anal manometric parameters don't allow the selection of surgical indication. The level of anastomosis (> or < 6 cm) influences the functional results: The rise of compliance with the pelvic J-pouch improves early functional results. Loop colostomy is a prudential attitude for anastomosis done low in the pelvis at less than 6 cm from the anal verge: functional results would get worse definitively in case of anastomotic leakage