Extramoucous transversal coloplasty – new method of reconstruction after rectum resection
Abstract
Background: In patients, diagnosed with rectal cancer in lower thirds of rectum, a total mesorectal excision is warranted. The aim is to preserve of all vegetative functions as well. Because of better functional results anastomosis with J-pouch is preferred procedure. Formation of colonic J-pouch can not always be performed due to anatomic reasons. Transverse coloplasty have the same functional results and can be constructed almost always. In some studies there were more dehiscence reported in the group with transverse coloplasty, probably because of impaired vascularization. With sparing of submucous layer better vascularization can be achieved and all advantages of transverse coloplasty preserved.
Methods: After preparing the patient following the principles of enhanced recovery surgery, resection of rectum by the oncologic principles is done. Colon is prepared for reconstruction and alongside of tenia the incision of muscular layer is done a few centimeters above the predicted anastomosis. The incision is 6 to 8 centimeters long. After the separation of muscular layer incision is sutured transversely. Submucous layer must not be opened or divided in order to obtained better vascularization of the terminal anastomosis and lower fecal inoculation. Postoperative treatment and follow-up is regular.
Conclusions: Extramucous transverse coloplasty can obtain functions of reservoir for neorectum and improve quality of life in a same way transverse coloplasty can. With preservation of submucous layer the vascularization of anastomosis is better and therefore the rate of dehiscence lower. For final consent more randomized studies have to be performed.
Downloads
References
Goliger JC, Dukes CE, Bussey HJ. Local recurrences after sphincter – saving excision for carcinomas of the rectum and rectosigmoids. Br J Surg 1951; 39: 199–211.
Heald RJ. The »holy plane« of rectal surgery. JR Soc Med 1988; 81: 503–8.
Pollet WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrences rates after curative anterior resection for carcinoma of rectum. Ann Surg 1983; 198: 159–63.
Williams NS, Johnston D. Survival and recurrence after spincter saving resection and abdominoperineal resection for carcinoma of middle third of the rectum. Br J Surg 1984; 71: 278–82.
Karanjia ND, Schache DJ, North WR, Heald RJ. »Close shaving« in anterior resection. Br J Surg 1990; 77: 510–2.
Stelzner F. Das echte und das falsche Lokalrecidiv nach der Kontinenzresektion des Rectumcarcinoms. Die Wertung des Mesorectums. Chirurg 1996; 67: 611–20.
Tytherleigh MG, McMortensen NJ. Options for sphincter preservation in surgery for low rectal cancer. Br J Surg 2003; 90: 922–33.
Rullier E, Laurent C, Bretagol F, Rullier A, Vendrely V, Zerbib F. Sphincter saving resection for all rectal carcinomas. The end of the 2-cm distal rule. Ann Surg 2005; 241: 465–9.
Heald RJ, Moran BJ, Ryall RD, Sexton R, Macfarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision. Ann Surg 1998; 133: 894–9.
Havenga K, DeRuiter MC, Enker WE, Welvaart K. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer. Br J Surg 1996; 83: 384–8.
MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993; 341: 457–60.
Molloy RG, Moran KT, Coulter J, Waldron R, Kirwan WO. Mechanism of sphincter impairment following low anterior resection. Dis Colon Rectum 1992; 35: 462–4.
Lewis WG, Martin IG, Williamson ME, Stephenson BM, Holdsworth PJ, Finan PJ, Johnston D. Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma? Dis Colon Rectum 1995; 38: 259–63.
Jehle EC, Haehnel T, Starlinger MJ, Becker HD. Level of the anastomosis does not influence functional outcome after resection for rectal cancer. Am J Surg 1995; 169: 147–53.
Miller AS, Lewis WG, Williamson ME, Sagar PM, Holdsworth PJ, Johnston D. Does eversion of the anorectum during restorative proctocolectomy influence functional outcome? Dis Col Rec 1996; 39: 489–93.
Pedersen IK, Christiansen J, Hint K, Jensen P, Olsen J, Mortensen PE. Anorectal function after low anterior resection for carcinoma. Ann Surg 1986; 204: 133–5.
Miller S, Lewis WG, Williamson ME, Holdsworth PJ, Johnston D, Finan PJ. Factors that influence the outcome after coloanal anastomosis for carcinoma of the rectum. Br J Surg 1995; 38: 1327–30.
Lazortes F, Fages P, Chiotasso P, Lemozy J, Bloom E. Resection of the rectum with construction of a colonic reservoir and coloanal anastomosis for carcinoma of the rectum. Br J Surg 1986; 73: 136–8.
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: 139–41.
Huber FT, Herter B, Siewert JR. Colonic pouch vs. side-to-end anastomosis in low anterior resection. Dis Colon Rectum 1999; 42: 896–902.
Tsunoda A, Shibusawa M, Kusano M. Anorectal function after anterior resection with side-to-side anastomosis for carcinoma of rectum. Dis Col Rec 1999; 42: 77–81.
Z’graggen K, Maurer CA, Birrer S, Giachino D, Kern B, Buchler MW. A new surgical concept for rectal replacement after low anterior resection: the transverse coloplasty pouch. Ann Surg 2001; 234: 780–5.
Z’graggen K, Maurer CA, Mettler D, Stoupis C, Wildi S, Buchler MW. A novel colon pouch and its comparison with straight coloanal and colon J-pouch-anal anastomosis: preliminary results in pigs. Surgery 1999; 125: 105–12.
Kusunoki M, Soji Y, Yanagi H, Hatada T, Fujita S, Sakanoue Y, et al. Function after anoabdominal rectal resection and colonic J-pouch-anal anastomosis. Br J Surg 1991; 78: 1434–8.
Benoist S, Panis Y, Boleslawski E, Hautefuille P, Valleur P. Functional outcome after coloanal versus low colorectal anastomosis for rectal carcinoma. J Am Coll Surg 1997; 185: 114–9.
Joo JS, Latulippe JF, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of colonic J-pouch sustained? Dis Colon Rectum 1999; 41: 740–6.
Furst A, Burghofer K, Hutzel L, Jauch KW. Neorectal reservoir is not the functional principle of the colonic J-pouch. Dis Colon Rectum 2002; 45: 660–7.
Ramirez JM, Mortensen NJ, Takeuchi N, Smilgin Humphreys MM. Colonic J-pouch rectal reconstruction – is really a neorectum? Dis Colon Rectum 1996; 39: 1286–8.
Seow-Choen F, Goh HS. Prospective randomised trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 1995; 82: 608–10.
Hallbook O, Nystrom PO, Sjodahl R. Physiologic characteristics of straight and colonic J-pouch anastomoses after rectal excision for cancer. Dis Colon Rectum 1997; 40: 332–8.
Ommer A, Girona-Johannkemper M, Jung KP, Berg E. Total mesorectal excision and colonic-J-pouch-anal anastomosis in the therapy of low rectal carcinoma-results in 116 patients. Zebtralbl Chir 2002; 127: 775–80.
Amin AI, Hallbook O, Lee AJ, Sexon R, Moran BJ, Heald RJ. 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: 33–7.
Hida J, Yoshifuji T, Tokoro T, Inoue K, Matsuzaki T, Okuno K, et al. Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up. Dis Colon Rectum 2004; 47: 1578–85.
Portier G, Platonoff I, Lazortes F. Long-term functional results after straight or colonic J-pouch coloanal anastomosis. Recent Results Cancer Res 2005; 165: 191–5.
Bittorf B, Stadelmaier U, Gohl J, Hohenberger W, Matzel KE. Functional outcomes after intersphincteric resection of the coloanal anastomosis in low rectal cancer. Eur J Surg Oncol 2004; 30: 260–5.
Kusunoki M, Soji Y, Yanagi H, Fujita S, Hatada T, Sakanoue Y, Yamamura T, Utsunomiya J. Modified anoabdominal rectal resection and colonic J-pouch anal anastomosis for lower rectal carcinoma: preliminary report. Surgery 1992; 112: 876–83.
Rullier E, Sa Cunha A, Couderc P, Ruiller A, Gontier R, Saric J. Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 2003; 90: 445–51.
Takase Y, Oya M, Komatsu J. Clinical and functional comparison between stapled colonic J-pouch low rectal anastomosis and hand-sewn colonic J-pouch anal anastomosis for very low rectal cancer. Surg Today 2002; 32: 315–21.
Heah SM, Seow-Choen F, Eu KW, Ho YH, Tang CL. Prospective, randomized trial comparing sigmoid vs. descending colonic J-pouch after total rectal excision. Dis Colon Rectum 2002; 45: 322–8.
Williams N, Seow-Choen F. Physiological and functional outcome following ultra-low anterior resection with colon pouchanal anastomosis. Br J Surg 1998; 85: 1029–35.
Hida J, Yasutomi M, Maruyama T, Fujimoto K, Nakajima A, Uchida 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: 558–63.
Sailer M, Fuchs KH, Fein M, Thiede A. Randomised clinical trial comparing quality of life after straight and pouch coloanal reconstruction. Br J Surg 2002; 89: 1108–17.
Hida J, Yasutomi M, Fujimoto K, Okuno K, Ieda S, Machidera N, et al. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch: prospective, randomised study for determination of optimum pouch size. Dis Colon Rectum 1996; 39: 986–91.
Dennett ER, Parry BR. Misconceptions about the colonic J-pouch. Dis Colon Rectum 1999; 42: 804–11.
Harris GJ, Lavery IJ, Fazio VW. 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: 1304–8.
Remzi FH, Fazio VW, Gorgun E, Zutshi M, Church JM, Lavery IC, Hull TL. Quality of life, functional outcome, and complications of coloplasty pouch after low anterior resection. Dis Colon Rectum 2005; 48: 735–43.
Mantyh CR, Hull TL, Fazio VW. Coloplasty in low colorectal anastomosis: manometric and functional comparison with straight and colonic J-pouch anastomosis. Dis Colon Rectum 2001; 44: 37–42.
Ho YH, Brown S, Heah SM, Tsang C, Seow-Choen F, Eu KW, Tang CL. Comparison of J-pouch and coloplasty pouch for rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak results. Ann Surg 2002; 236: 49–55.
Furst A, Suttner S, Agha A, Beham A, Jauch KW. Colonic J-pouch vs. coloplasty following resection of distal rectal cancer: early results of a prospective, randomised, pilot study. Dis Colon Rectum 2003; 46: 1161–6.
Pimentel JM, Duarte A, Gregorioa C, Souto P, Patricio J. Transverse coloplasty pouch and colonic J-pouch for rectal cancer – a comparative study. Colorectal Dis 2003; 5: 465–70.
Heriot AG, Tekkis PP, Constantinides V, Paraskevas P, Nicholls RJ, Darzi A, Fazio VW. Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection. Br J Surg 2006; 93: 19–32.
Ulrich A, Z’graggen K, Schmitz-Winnenthal B, Weitz J, Buchler MW. The transverse coloplasty pouch. Langenbecks Arch Surg 2005; 390: 355–60.
Kanne V, Kim NH, Ulrich B. The transverse coloplasty pouch TCP-function and subjective judgement in comparison with the surgical more complicated J-pouch. Zentralbl Chir 2002; 127: 781–5.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
