Objective: To analyze the feasibility, safety, complication and death rates, and early functional results of the transverse coloplasty pouch procedure after low anterior rectal resection and total mesorectal excision.
Summary Background Data: The authors previously developed a novel neorectal reservoir, the transverse coloplasty pouch, in an animal model; they report the first clinical data of a prospective phase 1 study.
Methods: Forty-one patients underwent low anterior rectal resection with total mesorectal excision for rectal cancer (n = 37) or benign pathology (n = 4). The continuity was restored with a transverse coloplasty pouch anastomosis, and the colon was defunctionalized for 3 months. Patients were followed up at 2-month intervals for functional outcome.
Results: Intraoperative complications occurred in three patients (7%), none related to the transverse coloplasty pouch. There were no hospital deaths and the total complication rate was 27% (11/41); an anastomotic leakage rate of 7% was recorded. The stool frequency was 3.4 per 24 hours at 2 months follow-up and gradually decreased to 2.1 per 24 hours at 8 months. Stool dysfunctions such as stool urgency, fragmentation, and incontinence grade 1 and 2 were regularly observed until 6 months; the incidence significantly decreased thereafter. None of the patients had difficulties in pouch evacuation.
Conclusions: The transverse coloplasty pouch is a small-volume reservoir that can safely be used for reconstruction after sphincter-preserving rectal resection. The early functional outcome is favorable and can be compared to other colonic reservoirs. The concept of reducing early dysfunction seen after straight coloanal anastomosis and avoiding long-term problems of pouch evacuation is supported by this study. Future trials will compare the transverse coloplasty pouch with other techniques of restorative resections of the rectum.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422137 | PMC |
| http://dx.doi.org/10.1097/00000658-200112000-00009 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Textbook anastomotic success in patients with low rectal cancer treated by intersphincteric resection: reappraising surgical, oncological, and functional outcomes.
Updates Surg
September 2024
Department of Colorectal Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
Article Synopsis
- This study redefined success criteria after intersphincteric resection (ISR) for low rectal cancer (LRC) by introducing "textbook anastomotic success" (TASS), focusing on surgical, oncological, and functional outcomes.
- In a retrospective analysis of 259 LRC patients treated with ISR, 48.3% achieved TASS, which required the absence of complications, ileostomy closure without severe dysfunction, and no local recurrence within two years.
- Factors like male sex, hypertension, and previous treatment methods were linked to lower chances of achieving TASS, while factors like transverse coloplasty pouch and higher anastomosis level improved the likelihood, with a nomogram predicting TASS outcomes showing
Reconstructive techniques following low anterior resection for carcinoma of the rectum.
Minerva Surg
February 2024
Department of Surgical Gastroenterology, Amrita Hospitals, Faridabad, India.
Introduction: Multiple reconstructive techniques have been described for reconstruction after a low anterior resection for carcinoma rectum. Colonic J pouch (CJP), Side to end anastomosis (SEA), transverse coloplasty pouch (TCP) and Straight Colo-rectal/anal anastomosis were the most widely studied.
Evidence Acquisition: PubMed, Embase and Cochrane data base were searched for randomized, non-randomized studies and systematic reviews from inception of the databases till July 31, 2023.
Transverse Coloplasty Pouch versus Straight Coloanal Anastomosis Following Intersphincteric Resection for Low Rectal Cancer: the Functional Benefits May Emerge After Two Years.
J Gastrointest Surg
November 2023
Department of Colorectal Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
Purpose: This study aimed to compare the oncological and functional outcomes following intersphincteric resection (ISR) with transverse coloplasty pouch (TCP) or straight coloanal anastomosis (SCAA) for low rectal cancer.
Methods: A single-center retrospective analysis was performed on patients with low rectal cancer who received ISR between January 2016 and June 2021. The primary endpoint was to compare the outcomes of bowel function within 1 year, 1 to 2 years, and 2 years after ileostomy closure in patients undergoing two different bowel reconstruction procedures (TCP or SCAA).
Antiperistaltic Transverse Coloplasty: A Salvage Procedure in Extensive Bowel and Colorectal Resections to Avoid Intestinal Failure.
Ann Surg Oncol
November 2023
General and Digestive Surgery Department, University Hospital Son Espases, Health Research Institute of the Balearic Islands, Palma de Mallorca, Spain.
Introduction: After extensive small and colon resections, quality of life can be affected. We propose the antiperistaltic transverse coloplasty as a solution that allows for preservation of the transverse colon after both right and left colectomies while achieving a tension-free colorectal anastomosis slowing the transit and increasing the absorption time, resulting in better stool consistency and quality of life compared with an ileorectal anastomosis.
Methods: This technique was performed in a 41-year-old woman with Goblet cell adenocarcinoma of the appendix with peritoneal metastasis.
Reconstructive techniques following low anterior resection for carcinoma of the rectum: meta-analysis.
Br J Surg
February 2023
Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India.
Article Synopsis
- A network analysis (NMA) compared various reconstruction techniques after distal rectal cancer surgery, including straight colorectal anastomosis (SCA), colonic J pouch (CJP), side-to-end anastomosis (SEA), and transverse coloplasty (TCP).
- The analysis included data from 32 trials with 3072 patients, revealing that CJP provided better functional outcomes like lower stool frequency and improved incontinence scores compared to other methods.
- The study recommended CJP as the preferred technique due to its benefits, while highlighting TCP's higher risks of complications such as anastomotic leakage and strictures.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!