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The colon J-pouch as a cause of evacuation disorders after rectal resection: myth or fact?

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An Erratum to this article was published on 10 September 2008

Abstract

Background

Colon J-pouch (JCP) reconstructions result in a better functional outcome than straight coloanal anastomosis (SCA) in terms of continence and frequency of defecation after rectal resection but might be associated with more evacuation difficulties. In order to evaluate this hypothesis, we systematically reviewed the literature to collect data on evacuation disorders after rectal resection in randomized or otherwise comparative trials.

Materials and methods

Randomized controlled trials and comparative trials evaluating CJP versus SCA, latero-terminal anastomosis (LTA), and transverse coloplasty pouch (TCP) were ascertained by methodical search using Medline, Embase, and PubMed. Pooled estimates of outcomes were calculated for early-, intermediate-, and long-term follow-up. Primary meta-analysis outcomes were sensation of incomplete evacuation, prolonged evacuation, use of laxatives, use of enemas and suppositories, and stool fragmentation.

Results

When compared to SCA, CJP was associated with significantly less “prolongation of evacuation” but more “use of laxatives” in the intermediate-term follow-up, while both less “sensation of incomplete evacuation” and less “fragmentation” was found after CJP in the long-term. When compared to TCP, CJP was associated with significantly less fragmentation in the intermediate-term follow-up.

Conclusions

Evacuation disorders are a unique problem of low anterior resection and are not specifically related to the colon J-pouch.

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References

  1. Parc R, Tiret E, Frileux P, Moszkowski E, Loygue J (1986) Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma. Br J Surg 73:139–141

    Article  PubMed  CAS  Google Scholar 

  2. Lazorthes F, Fages P, Chiotasso P, Lemozy J, Bloom E (1986) Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum. Br J Surg 73:136–138

    Article  PubMed  CAS  Google Scholar 

  3. Heriot AG, Tekkis PP, Constantinides V, Paraskevas P, Nicholls RJ, Darzi A, Fazio VW (2006) Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection. Br J Surg 93:19–32

    Article  PubMed  CAS  Google Scholar 

  4. Koh PK, Tang CL, Eu KW, Samuel M, Chan E (2006) A systematic review of the function and complications of colonic pouches. Int J Colorectal Dis 22:543–548

    Article  PubMed  Google Scholar 

  5. Berger A, Tiret E, Parc R, Frileux P, Hannoun L, Nordlinger B, Ratelle R, Simon R (1992) Excision of the rectum with colonic J pouch-anal anastomosis for adenocarcinoma of the low and mid rectum. World J Surg 16:470–477

    Article  PubMed  CAS  Google Scholar 

  6. Nicholls RJ, Lubowski DZ, Donaldson DR (1988) Comparison of colonic reservoir and straight colo-anal reconstruction after rectal excision. Br J Surg 75:318–320

    Article  PubMed  CAS  Google Scholar 

  7. Mortensen NJ, Ramirez JM, Takeuchi N, Humphreys MM (1995) Colonic J pouch-anal anastomosis after rectal excision for carcinoma: functional outcome. Br J Surg 82:611–613

    Article  PubMed  CAS  Google Scholar 

  8. Kusunoki M, Yanagi H, Shoji Y, Yamamura T, Utsunomiya J (1997) Anoabdominal rectal resection and colonic J pouch-anal anastomosis: 10 years’ experience. Br J Surg 84:1277–1280

    Article  PubMed  CAS  Google Scholar 

  9. Hida J, Yasutomi M, Fujimoto K, Okuno K, Ieda S, Machidera N, Kubo R, Shindo K, Koh K (1996) Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch. Prospective randomized study for determination of optimum pouch size. Dis Colon Rectum 39:986–991

    Article  PubMed  CAS  Google Scholar 

  10. Lazorthes F, Gamagami R, Chiotasso P, Istvan G, Muhammad S (1997) Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis. Dis Colon Rectum 40:1409–1413

    Article  PubMed  CAS  Google Scholar 

  11. Ho YH, Brown S, Heah SM, Tsang C, Seow-Choen F, Eu KW, Tang CL (2002) Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg 236:49–55

    Article  PubMed  Google Scholar 

  12. Lin JK, Wang HS, Yang SH, Jiang JK, Chen WS, Lin TC (2002) Comparison between straight and J-pouch coloanal anastomoses in surgery for rectal cancer. Surg Today 32:487–492

    Article  PubMed  Google Scholar 

  13. Z’Graggen K, Maurer CA, Birrer S, Giachino D, Kern B, Buchler MW (2001) A new surgical concept for rectal replacement after low anterior resection: the transverse coloplasty pouch. Ann Surg 234:780–785 (discussion 785–787)

    Article  PubMed  CAS  Google Scholar 

  14. Z’Graggen K, Maurer CA, Buchler MW (1999) Transverse coloplasty pouch. A novel neorectal reservoir. Dig Surg 16:363–366

    Article  PubMed  CAS  Google Scholar 

  15. von Flue MO, Degen LP, Beglinger C, Harder FH (1996) The ileocecal reservoir for rectal replacement in complicated radiation proctitis. Am J Surg 172:335–340

    Article  Google Scholar 

  16. Rink AD, Haaf F, Knupper N, Vestweber KH (2007) Prospective randomised trial comparing ileocaecal interposition and colon-J-pouch as rectal replacement after total mesorectal excision. Int J Colorectal Dis 22:153–160

    Article  PubMed  CAS  Google Scholar 

  17. Hamel CT, Metzger J, Curti G, Degen L, Harder F, von Flue MO (2004) Ileocecal reservoir reconstruction after total mesorectal excision: functional results of the long-term follow-up. Int J Colorectal Dis 19:574–579

    Article  PubMed  CAS  Google Scholar 

  18. Schumpelick V, Braun J (1991) Rectumresektion mit coloanaler Anastomose. Ergebnisse der Kontinenz und Radikalitat. Chirurg 62:25–31

    PubMed  CAS  Google Scholar 

  19. Enker WE, Stearns MW Jr., Janov AJ (1985) Peranal coloanal anastomosis following low anterior resection for rectal carcinoma. Dis Colon Rectum 28:576–581

    Article  PubMed  CAS  Google Scholar 

  20. Hallbook O, Pahlman L, Krog M, Wexner SD, Sjodahl R (1996) Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 224:58–65

    Article  PubMed  CAS  Google Scholar 

  21. Machado M, Nygren J, Goldman S, Ljungqvist O (2003) Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial. Ann Surg 238:214–220

    PubMed  Google Scholar 

  22. Ho YH, Tan M, Leong AF, Seow-Choen F (2000) Ambulatory manometry in patients with colonic J-pouch and straight coloanal anastomoses: randomized, controlled trial. Dis Colon Rectum 43:793–799

    Article  PubMed  CAS  Google Scholar 

  23. Oya M, Komatsu J, Takase Y, Nakamura T, Ishikawa H (2002) Comparison of defecatory function after colonic J-pouch anastomosis and straight anastomosis for stapled low anterior resection: results of a prospective randomized trial. Surg Today 32:104–110

    Article  PubMed  Google Scholar 

  24. Hida J, Yoshifuji T, Okuno K, Matsuzaki T, Uchida T, Ishimaru E, Tokoro T, Yasutomi M, Shiozaki H (2006) Long-term functional outcome of colonic J-pouch reconstruction after low anterior resection for rectal cancer. Surg Today 36:441–449

    Article  PubMed  Google Scholar 

  25. Hida J, Yoshifuji T, Tokoro T, Inoue K, Matsuzaki T, Okuno K, Shiozaki H, Yasutomi M (2004) Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up. Dis Colon Rectum 47:1578–1585

    Article  PubMed  Google Scholar 

  26. Seow-Choen F, Goh HS (1995) Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 82:608–610

    Article  PubMed  CAS  Google Scholar 

  27. Wang JY, You YT, Chen HH, Chiang JM, Yeh CY, Tang R (1997) Stapled colonic J-pouch-anal anastomosis without a diverting colostomy for rectal carcinoma. Dis Colon Rectum 40:30–34

    Article  PubMed  CAS  Google Scholar 

  28. Pimentel JM, Duarte A, Gregorio C, Souto P, Patricio J (2003) Transverse coloplasty pouch and colonic J-pouch for rectal cancer–a comparative study. Colorectal Dis 5:465–470

    Article  PubMed  CAS  Google Scholar 

  29. Dehni N Tiret E, Singland JD, Cunningham C, Schlegel RD, Guiguet M, Parc R (1998) Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch-anal anastomosis. Dis Colon Rectum 41:817–822 (discussion 822–823)

    Article  PubMed  CAS  Google Scholar 

  30. Harris GJ, Lavery IC, Fazio VW (2001) Function of a colonic J pouch continues to improve with time. Br J Surg 88:1623–1627

    Article  PubMed  CAS  Google Scholar 

  31. Peeters KC, van de Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, Steup WH, Wiggers T, Rutten HJ, Marijnen CA (2005) Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol 23:6199–6206

    Article  PubMed  CAS  Google Scholar 

  32. Lim JF, Tjandra JJ, Hiscock R, Chao MW, Gibbs P (2006) Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency. Dis Colon Rectum 49:12–19

    Article  PubMed  Google Scholar 

  33. Pollack J, Holm T, Cedermark B, Holmstrom B, Mellgren A (2006) Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum 49:345–352

    Article  PubMed  Google Scholar 

  34. Ammann K, Kirchmayr W, Klaus A, Muhlmann G, Kafka R, Oberwalder M, De Vries A, Ofner D, Weiss H (2003) Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Arch Surg 138:257–261

    Article  PubMed  Google Scholar 

  35. Kollmorgen CF, Meagher AP, Wolff BG, Pemberton JH, Martenson JA, Illstrup DM (1994) The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 220:676–682

    Article  PubMed  CAS  Google Scholar 

  36. Lundby L, Jensen VJ, Overgaard J, Laurberg S (1997) Long-term colorectal function after postoperative radiotherapy for colorectal cancer. Lancet 350:564

    Article  PubMed  CAS  Google Scholar 

  37. Nathanson DR, Espat NJ, Nash GM, D’Alessio M, Thaler H, Minsky BD, Enker W, Wong D, Guillem J, Cohen A, Paty PB (2003) Evaluation of preoperative and postoperative radiotherapy on long-term functional results of straight coloanal anastomosis. Dis Colon Rectum 46:888–894

    Article  PubMed  Google Scholar 

  38. Kienle P, Abend F, Dueck M, Abel U, Treiber M, Riedl S (2006) Influence of intraoperative and postoperative radiotherapy on functional outcome in patients undergoing standard and deep anterior resection for rectal cancer. Dis Colon Rectum 49:557–567

    Article  PubMed  Google Scholar 

  39. Rink AD, Vestweber KH (2002) Vulnerability of ileocoecal interposition pouch and colonic J-pouch to postoperative adjuvant radiotherapy. Zentralbl Chir 127:769–774

    Article  PubMed  CAS  Google Scholar 

  40. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 354:1896–1900

    Article  PubMed  CAS  Google Scholar 

  41. Mahid SS, Hornung CA, Minor KS, Turina M, Galandiuk S (2006) Systematic reviews and meta-analysis for the surgeon scientist. Br J Surg 93:1315–1324

    Article  PubMed  CAS  Google Scholar 

  42. Egger MDSG, Altman DG (2001). Systematic reviews in health care: meta-analysis in context. BMJ, London

  43. Gotzinger P, Wamser P, Herbst F (2001) [Colo-anal anastomosis: improvement of early function outcome by reconstruction with the colonic pouch]. Chirurg 72:49–53

    Article  PubMed  CAS  Google Scholar 

  44. Barrier A, Martel P, Gallot D, Dugue L, Sezeur A, Malafosse M (1999) Long-term functional results of colonic J pouch versus straight coloanal anastomosis. Br J Surg 86:1176–1179

    Article  PubMed  CAS  Google Scholar 

  45. Ikeuchi H, Kusunoki M, Shoji Y, Yamamura T, Utsunomiya J (1997) Functional results after “high” coloanal anastomosis and “low” coloanal anastomosis with a colonic J-pouch for rectal carcinoma. Surg Today 27:702–705

    Article  PubMed  CAS  Google Scholar 

  46. Portier G, Platonoff I, Lazorthes F (2005) Long-term functional results after straight or colonic J-pouch coloanal anastomosis. Recent Results Cancer Res 165:191–195

    Article  PubMed  Google Scholar 

  47. Tonelli F, Garcea A, Batignani G (2005) Different role of the colonic pouch for low anterior resection and coloanal anastomosis. Tech Coloproctol 9:15–20

    Article  PubMed  CAS  Google Scholar 

  48. Huber FT, Herter B, Siewert JR (1999) Colonic pouch vs. side-to-end anastomosis in low anterior resection. Dis Colon Rectum 42:896–902

    Article  PubMed  CAS  Google Scholar 

  49. Liang JT, Lai HS, Lee PH, Huang KC (2007) Comparison of functional and surgical outcomes of laparoscopic-assisted colonic J-pouch versus straight reconstruction after total mesorectal excision for lower rectal cancer. Ann Surg Oncol 14:1972–1979

    Article  PubMed  Google Scholar 

  50. Fazio VW, Zutshi M, Remzi FH, Parc Y, Ruppert R, Furst A, Celebrezze J Jr., Galanduik S, Orangio G, Hyman N, Bokey L, Tiret E, Kirchdorfer B, Medich D, Tietze M, Hull T, Hammel J (2007) A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 246:481–488 (discussion 488–490)

    Article  PubMed  Google Scholar 

  51. Ho YH, Tan M, Seow-Choen F (1996) Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic J pouch anastomoses. Br J Surg 83:978–980

    Article  PubMed  CAS  Google Scholar 

  52. Jiang JK, Yang SH, Lin JK (2005) Transabdominal anastomosis after low anterior resection: A prospective, randomized, controlled trial comparing long-term results between side-to-end anastomosis and colonic J-pouch. Dis Colon Rectum 48:2100–2108 (discussion 2108–2110)

    Article  PubMed  Google Scholar 

  53. Kanne V, Kim NH, Ulrich B (2002) Der Transverse Coloplastie Pouch (TCP)–Funktionalität und subjektives Empfinden verglichen mit dem operativ aufwendigeren J-Pouch. Zentralbl Chir 127:781–785

    Article  PubMed  CAS  Google Scholar 

  54. Matsuoka H, Masaki T, Sugiyama M, Atomi Y (2004) Large contractions in the colonic J-pouch as a possible cause of incomplete evacuation. Langenbecks Arch Surg 389:391–395

    Article  PubMed  Google Scholar 

  55. Willis S, Kasperk R, Braun J, Schumpelick V (2001) Comparison of colonic J-pouch reconstruction and straight coloanal anastomosis after intersphincteric rectal resection. Langenbecks Arch Surg 386:193–199

    Article  PubMed  CAS  Google Scholar 

  56. Bretagnol F, Troubat H, Laurent C, Zerbib F, Saric J, Rullier E (2004) Long-term functional results after sphincter-saving resection for rectal cancer. Gastroenterol Clin Biol 28:155–159

    Article  PubMed  Google Scholar 

  57. Gamagami R, Istvan G, Cabarrot P, Liagre A, Chiotasso P, Lazorthes F (2000) Fecal continence following partial resection of the anal canal in distal rectal cancer: long-term results after coloanal anastomoses. Surgery 127:291–295

    Article  PubMed  CAS  Google Scholar 

  58. Matzel KE, Stadelmaier U, Muehldorfer S, Hohenberger W (1997) Continence after colorectal reconstruction following resection: impact of level of anastomosis. Int J Colorectal Dis 12:82–87

    Article  PubMed  CAS  Google Scholar 

  59. Montesani C, Pronio A, Santella S, Boschetto A, Aguzzi D, Pirozzi R, D’Amato A, Vestri A (2004) Rectal cancer surgery with sphincter preservation: functional results related to the level of anastomosis. Clinical and instrumental study. Hepatogastroenterology 51:718–721

    PubMed  Google Scholar 

  60. Hida J, Yasutomi M, Maruyama T, Fujimoto K, Nakajima A, Uchida T, Wakano T, Tokoro T, Kubo R, Shindo K (1998) Indications for colonic J-pouch reconstruction after anterior resection for rectal cancer: determining the optimum level of anastomosis. Dis Colon Rectum 41:558–563

    Article  PubMed  CAS  Google Scholar 

  61. Temple LK, Bacik J, Savatta SG, Gottesman L, Paty PB, Weiser MR, Guillem JG, Minsky BD, Kalman M, Thaler HT, Schrag D, Wong WD (2005) The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum 48:1353–1365

    Article  PubMed  Google Scholar 

  62. Wilson TR, Alexander DJ, Kind P (2006) Measurement of health-related quality of life in the early follow-up of colon and rectal cancer. Dis Colon Rectum 49:1692–1702

    Article  PubMed  Google Scholar 

  63. Rauch P, Miny J, Conroy T, Neyton L, Guillemin F (2004) Quality of life among disease-free survivors of rectal cancer. J Clin Oncol 22:354–360

    Article  PubMed  Google Scholar 

  64. Pelissier EP, Blum D, Bachour A, Bosset JF (1992) Functional results of coloanal anastomosis with reservoir. Dis Colon Rectum 35:843–846

    Article  PubMed  CAS  Google Scholar 

  65. Hallbook O, Sjodahl R (1997) Comparison between the colonic J pouch-anal anastomosis and healthy rectum: clinical and physiological function. Br J Surg 84:1437–1441

    Article  PubMed  CAS  Google Scholar 

  66. Hida J, Yasutomi M, Maruyama T, Tokoro T, Wakano T, Uchida T (1999) Enlargement of colonic pouch after proctectomy and coloanal anastomosis: potential cause for evacuation difficulty. Dis Colon Rectum 42:1181–1188

    Article  PubMed  CAS  Google Scholar 

  67. Hida J, Yasutomi M, Maruyama T, Yoshifuji T, Tokoro T, Wakano T, Uchida T, Ueda K (1999) Detection of a rectocele-like prolapse in the colonic J-pouch using pouchography: cause or effect of evacuation difficulties? Surg Today 29:1237–1242

    Article  PubMed  CAS  Google Scholar 

  68. Hida J, Yasutomi M, Maruyama T, Tokoro T, Uchida T, Wakano T, Kubo R (1999) Horizontal inclination of the longitudinal axis of the colonic J-pouch: defining causes of evacuation difficulty. Dis Colon Rectum 42:1560–1568

    Article  PubMed  CAS  Google Scholar 

  69. Sailer M, Debus ES, Fuchs KH, Fein M, Beyerlein J, Thiede A (1999) Comparison of different J-pouches vs. straight and side-to-end coloanal anastomoses: experimental study in pigs. Dis Colon Rectum 42:590–595

    Article  PubMed  CAS  Google Scholar 

  70. Köninger JS, Butters M, Redecke JD, Z’Graggen K (2005) Evacuation of neorectal reservoirs after TME. Recent Results Cancer Res 165:180–190

    Article  PubMed  Google Scholar 

  71. Lewis WG, Holdsworth PJ, Sagar PM, Stephenson BM, Finan PJ, Johnston D (1994) Coordinated activity of the new “rectum” and anal sphincter after sphincter-saving resection of the rectum for colitis or carcinoma. Dis Colon Rectum 37:1012–1019

    Article  PubMed  CAS  Google Scholar 

  72. Otto IC, Ito K, Ye C, Hibi K, Kasai Y, Akiyama S, Takagi H (1996) Causes of rectal incontinence after sphincter-preserving operations for rectal cancer. Dis Colon Rectum 39:1423–1427

    Article  PubMed  CAS  Google Scholar 

  73. Kakodkar R, Gupta S, Nundy S (2006) Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome. Colorectal Dis 8:650–656

    Article  PubMed  CAS  Google Scholar 

  74. Rao GN, Drew PJ, Lee PW, Monson JR, Duthie GS (1996) Anterior resection syndrome is secondary to sympathetic denervation. Int J Colorectal Dis 11:250–258

    Article  PubMed  CAS  Google Scholar 

  75. Lewis WG, Martin IG, Williamson ME, Stephenson BM, Holdsworth PJ, Finan PJ, Johnston D (1995) Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma? Dis Colon Rectum 38:259–263

    Article  PubMed  CAS  Google Scholar 

  76. Shafik A, Mostafa RM, Shafik I, Ei-Sibai O, Shafik AA (2006) Functional activity of the rectum: A conduit organ or a storage organ or both? World J Gastroenterol 12:4549–4552

    PubMed  Google Scholar 

  77. Shafik A, Shafik AA, El Sibai O, Ahmed I, Mostafa RM (2006) Role of the rectosigmoidal junction in fecal continence: concept of the primary continent mechanism. Arch Surg 141:23–26

    Article  PubMed  Google Scholar 

  78. Shafik A, Doss S, Asaad S, Ali YA (1999) Rectosigmoid junction: anatomical, histological, and radiological studies with special reference to a sphincteric function. Int J Colorectal Dis 14:237–244

    Article  PubMed  CAS  Google Scholar 

  79. Koda K, Saito N, Seike K, Shimizu K, Kosugi C, Miyazaki M (2005) Denervation of the neorectum as a potential cause of defecatory disorder following low anterior resection for rectal cancer. Dis Colon Rectum 48:210–217

    Article  PubMed  Google Scholar 

  80. Oya M, Sugamata Y, Komatsu J, Ishikawa H, Nozaki M (2002) Poor neorectal evacuation as a cause of impaired defecatory function after low anterior resection: a study using scintigraphic assessment. Surg Today 32:111–117

    Article  PubMed  Google Scholar 

  81. Seike K, Koda K, Takiguchi N, Oda K, Miyazaki M (2003) Gas volume analysis and postoperative bowel functional disorders in patients who received anterior resection for rectal cancer. Dis Colon Rectum 46:661–666

    Article  PubMed  Google Scholar 

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Correspondence to Andreas D. Rink.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00423-008-0415-2

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Rink, A.D., Sgourakis, G., Sotiropoulos, G.C. et al. The colon J-pouch as a cause of evacuation disorders after rectal resection: myth or fact?. Langenbecks Arch Surg 394, 79–91 (2009). https://doi.org/10.1007/s00423-008-0364-9

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