Colonic pouch anastomosis after rectal excision for cancer
1996 (English)Doctoral thesis, comprehensive summary (Other academic)
Anastomoses at the level of the pelvic floor will become increasingly more common in rectal cancer surgery when total mesorectal excision is used as a standard procedure to obtain local mdicality. A consequence of such low anastomoses is increased risk of healing disturbances and poor distal bowel function, The aim of this thesis was to focus on reconstruction after total mesorectal excision.
A randomized trial comparing the conventional straight anastomosis (n=52) and the colonic pouch anastomosis (n=45) showed that the pouch patients had fewer bowel movements per 24 hours, less nocturnal evacuations, urgency and incontinence at one year after surgery. The superiority of colonic pouches could not, however, be verified by a general quality of life instrument, the Nottingham Health Profile. One disadvantage with the pouch reconstruction was that some patients experienced difficult evacuation.
The trial also showed less anastomotic leakage in the pouches. This may partly be attributable to the concept of side-to-end reconstruction, which had a better preserved blood flow at the site of anastomosis than the straight (end-to-end) alternative, as shown by intraoperative laser Doppler flowmetry.
In the search for specific mediators of the functional adaption after a restorative rectal excision two gut peptides, peptide YY and enteroglucagon, were sequentially measured in both plasma and neorectal mucosa after surgery. No major changes occurred.
Manovolumetric investigation of the rectal substitute showed that construction of colonic pouches restores volume, improves compliance and sensory function compared with straight anastomoses. Compared with healthy rectum, pouches exhibit sensory deficits and decreased compliance despite adequate volume, factors which may partly explain why some pouch patients experience impaired evacuation. Maximum volume of the pouches was positively correlated with degree of evacuation difficulty. This association was verified by logistic regression with adjustment for confounding factors.
Obviously colonic pouches cannot have the unique reservoir function of the healthy rectum. However, in-spite of physiological changes regarding sensory function, compliance, motility and reflex inhibition, patients having a colonic pouch anastomosis will usually experience satisfactory clinical bowel function.
Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 1996. , 56 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 504
Total mesorectal excision, low anterior resection, colonic pouch, coloanal anastomosis, neorectum, quality of life, laser-Doppler flowmetry, gut peptides, anorectal physiology
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-25655Local ID: 10031ISBN: 91-7871-766-3OAI: oai:DiVA.org:liu-25655DiVA: diva2:246203
1996-11-01, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (Swedish)
Mortensen, Neil J. M.
Papers, included in the Ph.D. thesis, are not registered and included in the posts from 1999 and backwards.2009-10-082009-10-082012-07-17Bibliographically approved