ABSTRACT
Rectal cancer is the second common gastrointestinal tumour and its surgical treatment varies according to its distance from anal verge. After low anterior resection and colorectal anastmosis, for upper 1/3 rectal tumour, patients usually have normal habits with minimal affection. However, for middle and lower rectal cancer, they require a pouch to minimize the functional disorders resulting from the rectal pouch and may be also related to the loss of normal anorectal sensation. To compare the functional results of coloplasty pouch [CP] versus the colonic J- pouch [JP], after low anterior resection. Thirty patients diagnosed to have an operable middle and low rectal carcinoma, were randomized into two equal groups, the J-pouch and the coloplasty group. All the patients underwent low anterior resection with temporary ileostomy diversion, after colo-anal asnastmosis with CP or JP formation. The patients had a preoperative and postoperative anal manometric study, at 6 months and 12 months interval after closure of ileostomy. This includes resting anal pressure, maximum squeeze pressure, and maximum tolerable volume, as well as the recto-anal inhibitory reflex. Patients had a questionnaire based on Hida et al. scoring system where different variables [evacuation, continence, urgency, perineal soiling and others] were graded from zero to two to quantify the overall functional results. There was no significant difference between both groups regarding intra-operative or postoperative complications, or hospital stay. Bowel evacuation was better for CP patients, at 6 months, however, it equalized in both groups with no significant difference at 1-year interval. Although, the resting anal pressure and the maximum squeeze pressure were lower than the preoperative values, but there was no significant difference between both groups after six months or one year duration. Finally there was a significant inverse correlation between the total functional score and the anasto-motic distance from the anal verge for both groups, the smaller the distance from the anal verge, the higher was the functional score [poorer function]. Patients with colo-plasty pouches were able to defer their bowel movement better, and had less nocturnal leak, at 6 months, however, bowel function equalized in both groups at 1 year, with no significant difference between both groups