Comparison of Performance and Clinical Outcome of Three Methods of Straight, Side-to-End, and Colonic J-Pouch Colorectal Anastomosis in Patients with Rectal Cancer

There are several techniques for preserving the rectum in Low Anterior Resection (LAR) and preventing permanent ostomy. However, the superiority of these techniques is still under debate. The aim of this study was to compare the performance and clinical outcome of three methods of straight, side-to-end, and colonic J-pouch colorectal anastomosis in patients with rectal cancer referred to Imam Khomeini Hospital in Sari.

In this prospective single-blind clinical trial, all 75 patients with rectal cancer over the age of 18 years with primary rectal tumor with resection capability and position of the lower or middle rectum 4 to 12 cm from the anal canal, during the period of 2017 to 2018 referred to Imam Khomeini Hospital in Sari, were randomly divided into three groups of 25 people using block sampling: (the first group: low anterior resection with straight anastomosis, the second group: surgery with colonic J-pouch and the third group: side-to-end anastomosis). Functional outcomes (measured by Wexner criteria) and surgical complications were compared in the two groups, and patients were followed up to evaluate the functional features of the anastomosis.

60 patients including 29 women (48.33%) and 31 men were analyzed. The mean age of patients was 58.32±14.91 years. The mean length of surgery, median hospitalization and median bleeding in patients undergoing J-pouch anastomosis were 178.65±14.21 minutes, four days and 500 ml, respectively. No surgery-related complications were seen in the three groups. The Wexner criterion showed the superiority of patients who underwent J-pouch anastomosis surgery in the variables of daily defecation frequency, fecal incontinence and emergency defecation compared to the other two groups (p<0.001, p<0.005, p<0.022).

The results of this study showed that the performance indices of patients with rectal cancer in people undergoing J-pouch anastomosis are better compared to side-to-end and straight methods.