The blind colonic J-pouch: an original technique to reduce the surgical risk in the treatment of extra-peritoneal rectal cancer (Int J Colorectal Dis (2007) 22:1361–1367 DOI 10.1007/s00384-007-0316-9)

Gabriele Valenti & Costantino Campisi &
Alessandro Testa & Alessandro Arturi & Giovanni Torin

Accepted: 5 April 2007 / Published online: 6 June 2007
Copyright Springer-Verlag 2007

The blind colonic J-pouch: Abstract

Background Low and ultra-low anterior resection with colo-rectal or colo-anal anastomosis is accompanied by high frequency of postoperative anastomotic leakage. The aim of this report is to describe a novel technical approach to colorectal reconstruction.

Materials and methods The innovative procedure introdu- ces the principle of ‘no anastomosis–no leakage’, and it can be performed both laparascopically or by means of a laparotomy. It consists of a simple colo-rectal or colo-anal apposition with latero-terminal modality, with the creation of a colonic J-pouch called “blind” because it remains closed in the external site and the anus is sealed up. The surgery is completed with an exclusive derivative colosto- my, and the reconstruction of the intestinal continuity is postponed to a second operation. Within 4–6 weeks from the first, the blind pouch is opened, the communication between the anus and the colon is established, and the colostomy is closed and reduced in the peritoneal cavity. Results and conclusions Ethics committee of our hospital approved the experimental program; actually, we are finishing the first step on 15 patients, and preliminary clinical results look like to be very good. The innovative methodology is here described in advance, and we pledge to spread clinical results in a subsequent report.


Blind pouch technique
Ultra-low and colo-anal anastomosis
Anastomotic leakage prevention

The blind colonic J-pouch: Introduction

It is our purpose to propose an original surgical technique devoted to drastically reduce the high surgical complication rates secondary to anterior resections of rectum after low and ultra-low colo-rectal or colo-anal anastomosis.

It is based on the principle of “no anastomosis–no leakage”, and it consists of a simple apposition of tissues instead of anastomosis. Moreover, this novel technique would be performed instead of ileo-rectal and ileo-anal anastomosis after a total or subtotal colectomy for inflam- matory pathologies.

This report will describe step by step the surgical method involved in this technique, and we will specifically refer to the colonic J-pouch because it is conceptually easier to adapt these procedures to the more simple side-to-end anastomosis without pouch.

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