Colorectal/Coloanal Anastomosis Colonic J-Pouch, Coloplasty, Side-to-End Anastomosis: Techniques

Following a resection of a rectal cancer with a total mesorectum excision, bowel continuity can be restored by different types of coloanal anastomosis: straight anastomosis, J-pouch, coloplasty, or side-to-end. A J-pouch is made after resection of the rectum. Two 6-cm colon limbs are folded up and a colotomy is made at the apex of the J. A side-to-side anastomosis is then performed on the antimesenteric side for 7 cm. For coloplasty, an 8- to 10-cm longitudinal incision is made along the antimesenteric side, starting 4 cm above the distal cut edge and the incision is closed transversely. A side-to-end anastomosis can be made using a stapler device introduced through the anus or through the distal end of the colon or hand-sewn via a perineal approach. Every coloanal anastomosis should be drained and an ileostomy should be constructed. It is important to know the different techniques for coloanal anastomosis to face difficult situations, such as bulky mesentery, small pelvic space, and misfiring of stapling device.