Dysfunction in Defecation and Its Treatment after Rectal Excision

V arious types of dysfunction in defecation are known to develop after low anterior resection for/in the treatment of rectal cancer. In particular, the lower the level of anastomosis, the more serious the disturbance. This disturbance is characterized by a variable frequency of defecation and urgency. To improve this condition, colonic J-pouch anal anastomosis was reported as an option. In this technique, a colonic J-pouch was constructed and anastomosis was formed with the anus to restore stool reservoir function. This technique has been performed since 1988 at our institution. It was observed that approximately 3 years after the operation stool frequency was significantly decreased, the development of urgency was reduced, and the defecation function was improved, compared with straight coloanal anastomosis. This improvement in the function of defecation appeared to be largely influenced by both an increase (approximately twice) in the capacity and the compliance of the colonic pouch. Since these results were not derived from randomized trials, the published results of randomized trials were investigated, and are also discussed below.