Function of a colonic J pouch continues to improve with time

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Abstract
Background: J pouch–anal anastomosis is thought to give superior functional results to straight coloanal anastomosis after rectal resection. Follow-up studies have suggested that this improvement is not maintained and that evacuatory difficulties may increase. Methods: Some 119 consecutive patients had a coloanal anastomosis after resection for rectal carcinoma over 113 months, 62 with a J pouch and 57 with a straight coloanal anastomosis. Functional results were determined by patient questionnaire. The two groups were compared for the first and second 5-year intervals of study. Results: Patients who had a J pouch had significantly better median Kirwan continence scores for the duration of the study and 5–9 years after surgery: 1 versus 2 (P = 0·05) and 1 versus 2 (P < 0·01), respectively. Some 5–9 years after surgery the median number of nocturnal bowel movements was significantly lower in patients who had a J pouch than in those with a straight coloanal anastomosis (0 versus 1; P = 0·02). Similarly, significantly better results were seen with regard to evacuation difficulties and urgency of defaecation. Conclusion: The function of the J pouch was superior to that of the straight coloanal anastomosis and appeared to improve with time.