Restorative proctectomy, reconstruction of continuity with or without colon J pouch

Of 63 patients undergoing deep anterior resection of the rectum, 39 patients received a straight colo-anal anastomosis (CAA), 24 additionally had a colon-j-pouch (CPA) constructed. Local septic complications occurred in 12.5% of patients after pouch-anal anastomosis compared to 20.5% after colo-anal anastomosis: stool frequency, after pouch-anal anastomosis was 3.3 per 24 h compared to 5.2 per 24 h after straight anastomosis within the first year after ileostomy closure (p = 0.053); continence was slightly better in the pouch group (n.s.); and anal manometry showed a significant postoperative decrease only in resting pressure after straight colo-anal anastomosis (p < 0.001). Pouch construction should be considered after deep rectal resection, as it seems to improve functional outcome and has fewer local septic complications than straight anastomosis.