%0 Journal Article
%T Coloplasty Neorectum versus Straight Anastomosis in Low Rectal Cancers
%A Fazl Q. Parray
%A Javaid A. Magray
%A Manzoor Ahmad Dar
%A Nisar A. Chowdri
%A Rauf A. Wani
%A Natasha Thakur
%J ISRN Surgery
%D 2014
%R 10.1155/2014/382371
%X Introduction. Patients with the diagnosis of carcinoma rectum after random allocation were assigned to 2 groups. One group was subjected to total mesorectal excision with coloplasty neorectum reconstruction and another group to total mesorectal excision with straight anastomosis. This randomization was done by odds and even method by the sister in charge of the ward to avoid bias in randomization. The study included 42 patients with diagnosis of carcinoma rectum from 4 to 12 centimeters from anal verge. Composite incontinence score, bladder function, and sexual function were considered as the main outcome measures. Results. All patients of transverse coloplasty group had mild or moderate composite incontinence score while 7 (36.8%) patients of straight anastomosis group had a severe score at 7th POD ( ). At 6 months, 100% patients in transverse coloplasty group had a nil score which was not achieved by any of the patients in the other group. An intragroup comparison showed an improvement in score with time in both groups more marked in transverse coloplasty group. Conclusion. Transverse coloplasty group showed a better QOL so far as anal incontinence is considered. However, no statistically significant difference was achieved when comparing bladder and sexual dysfunction between the two groups. 1. Introduction A better understanding of oncological factors governing tumor spread in rectal cancer, the advent of total mesorectal excision (TME) with nerve sparing, use of neoadjuvant chemoradiation, and the development of stapling devices have made it possible to avoid a permanent stoma in most of the patients undergoing surgery for low rectal carcinomas. A low anterior resection with restoration of bowel continuity is the surgical procedure of choice offered to such patients. However, performing a straight coloanal anastomosis for restoring the bowel continuity may be complicated by ¡°anterior resection syndrome (ARS)¡± characterized by increase in defecatory frequency, urgency, and incontinence [1, 2]. This syndrome resulting from loss of rectal reservoir may affect up to 90% of patients with straight coloanal anastomosis and may worsen the quality of life in about 39% of patients [3]. Lazorthes and Parc developed the colonic J-pouch-anal and low rectal anastomosis in 1986 [4, 5], and its functional superiority over straight coloanal anastomosis was shown in randomized controlled trials [6¨C9]. However, 10¨C30% of patients with colonic J-pouch may experience some late evacuation problems with incomplete defecation requiring the use of laxatives, suppositories,
%U http://www.hindawi.com/journals/isrn.surgery/2014/382371/