Do we need a pouch after intersphincteric resection

In the early years of sphincter saving surgery for rectal cancer, an anorectal remnant of at least 6 cmseemed to be necessary for a satisfactory continence. Especially the sensory function of the lower rectum was assumed to be essential for a good postoperative function [1]. Gaston [2] has shown that after extensive resection of the rectum the rectoanal reflex was absent and continence was impaired. He showed on patients with rectal anastomoses in various levels that a minimum of 7 cm of rectal stump was necessary to elicit the rectoanal reflex, demonstrating an intact afferent and efferent nerve supply. His work showed very clearly that the lower rectum is an integral part of the sphincter mechanism. Although further clinical experience with different kinds of sphincter saving procedures did not confirm that a small rectal stump leads to incontinence, the important interaction between the lower rectum, the anal canal and the sphincter muscles is still valid.