J-pouch: an original technique to reduce the surgical risk in the treatment of extra-peritoneal rectal cancer

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 introduces 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 colostomy, 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.