***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Functional variables after coloanal anastomosis or anastomosis with J pouch were investigated in 40 patients in a prospect i ve r and omized study .  Continence for liquids and gas control were superior after J pouch anastomosis compared with coloanal reconstruction . The neorectal capacity was higher after J pouch anastomosis . The perception threshold for stool filling was higher in patients with J pouch resembling those values observed preoperatively . Quality of life was improved in subjects with with J pouch , although differences did not reach a significant level Objective To assess the efficacy of a novel coloplasty colonic pouch design in optimizing bowel function after ultralow anterior resection . Summary Background Data A colonic J-pouch may reduce excessive stool frequency and incontinence after anterior resection , but at the risk of evacuation problems . Experimental surgery on pigs has suggested that a coloplasty pouch ( CP ) may be a useful alternative . Although CP has recently been shown to be feasible in patients , there is no r and omized controlled trial comparing bowel function with the J-pouch . Methods After anterior resection for cancer , patients were allocated to either  J-pouch or CP-anal anastomoses .  Continence scoring , anorectal manometry , and endoanal ultrasound assessment s were made before surgery . All complications were recorded , and these preoperative assessment s were repeated at 4 months . The assessment s were repeated again at 1 year , and a quality of life question naire was added . Results Eighty-eight patients were recruited from October 1998 to April 2000 . Both groups were well matched for age , gender , staging , adjuvant therapy , and mean follow-up . There were no differences in the intraoperative time and hospital stay . CP result ed in more anastomotic leaks . At 4 months , J-pouch patients had 10.3 % less stool fragmentation but poorer stool deferment and more nocturnal leakage . However , there were no differences in the bowel function , continence score , and quality of life at 1 year . There were no differences in the anorectal manometry and endoanal ultrasound findings . Conclusions Coloplasty pouches result ed in more anastomotic leaks and minimal differences in bowel function . At present , the J-pouch remains the benchmark for routine clinical practice , and due care ( including defunctioning stoma ) should be exercised in situations requiring CP Objectives To compare a colonic J-pouch or a side-to-end anastomosis after low-anterior resection for rectal cancer with regard to functional and surgical outcome . Summary Background Data A complication after restorative rectal surgery with a straight anastomosis is low-anterior resection syndrome with a postoperatively deteriorated anorectal function . The colonic J-reservoir is sometimes used with the purpose of reducing these symptoms . An alternative method is to use a simple side-to-end anastomosis . Methods One-hundred patients with rectal cancer undergoing total mesorectal excision and colo-anal anastomosis were r and omized  to receive either a colonic pouch or a side-to-end anastomosis using the descending colon . Surgical results and complications were recorded . Patients were followed with a functional evaluation at 6 and 12 months postoperatively . Results Fifty patients were r and omized to each group . Patient characteristics in both groups were very similar regarding age , gender , tumor level , and Dukes ’ stages . A large proportion of the patients received short-term preoperative radiotherapy ( 78 % ) . There was no significant difference in surgical outcome between the 2 techniques with respect to anastomotic height ( 4 cm ) , perioperative blood loss ( 500 ml ) , hospital stay ( 11 days ) , postoperative complications , reoperations or pelvic sepsis rates . Comparing functional results in the 2 study groups , only the ability to evacuate the bowel in < 15 minutes at 6 months reached a significant difference in favor of the pouch procedure . Conclusions The data from this study show that either a colonic J-pouch or a side-to-end anastomosis performed on the descending colon in low-anterior resection with total mesorectal excision are methods that can be used with similar expected functional and surgical results A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Background : Total mesorectal excision ( TME ) and colonic J pouch reconstruction has been widely practice d for mid- or low-rectal cancer . However , the laparoscopic version of TME has never been described . Methods : Five patients suffering from newly diagnosed mid- to low-rectal cancer were seen between March and July 1999 . These five patients were selected for laparoscopic TME and colonic J pouch reconstruction because preoperative investigations revealed resectable tumor without extrarectal disease . Results : There were three men and two women with a mean age of 61 years . The average body weight was 69 kg ( range , 57 - 80 ) . None of the patients had had previous abdominal operations . In all five patients , the tumor was located within 9 cm from anal verge . The average size of the main incision was 5 cm . All patients had a covering  ileostomy at the end of the procedure . The mean operating time was 208 min ; average blood loss was 158 ml ; and mean hospital stay was 10.6 days . Three patients had Dukes ' B disease and two had Dukes ' C disease . The resection margins ( proximal , circumferential , and distal ) were all clear . There were no deaths or major complications . Two patients suffered from transient urinary retention . After ileostomy closure , the median frequency of bowel motion was twice per day at 6-month follow-up . Neither incontinence nor nocturnal soiling was reported . Conclusion : To the best of our knowledge , this is the first published series of such an operation . With good patient selection , laparoscopic-assisted TME and colonic J pouch-anal anastomosis is safe and feasible The efficacy of colon-J-pouch anal anastomosis ( CPAA ) in reducing defecatory frequency and urgency and the incidence of anastomotic fistulas has been proved by several studies but only as compared to straight colo-anal anastomosis ( CAA ) of the end-to-end type . We investigated the role played by the colon pouch in the strict sense , without the influence of a different CAA model , in a r and omised prospect i ve study comparing CPAA and straight side-to-end CAA . Over the period from 1994 to 1998 we selected 66 of 118 patients operated on for rectal cancer : a CPAA was constructed in 35 ( group P ) and a direct side-to-end CAA in 31 ( group D ) . The two groups were well matched for surgeon , type of patient , stage of disease and incidence of radiotherapy and presented no differences in operative mortality , general and anastomotic morbidity , or need for reoperation . Functional results : after 3 , 12 and 36 months , defecatory frequency > or = 4 movements/day was observed in 93.4 , 67.7 and 41.6 % of cases , respectively , in group D as against 25.7 , 14.2 and 13 % , respectively , in group P ( P < 0.05 ) , while defecatory urgency was recorded in 77.4 , 35.4 and 27.9 % of cases , respectively , in group D as against 34.2 , 17.1 and 9 % , respectively , in group P ( p < 0.05 ) . In the long term , incontinence was also significantly lower in group P. The colon pouch improves sphincter rehabilitation after anal recanalization compared to straight side-to-end CAA . It does not affect anastomotic morbidity but affords a protective effect on function in irradiated patients . CPAA proves to be the optimal reconstruction option after excision of the rectum Introduction : Colonic pouches have been used for 20 years to provide reservoir function after reconstructive proctectomy for rectal cancer . More recently coloplasty has been advocated as an alternative to a colonic pouch . However there have been no long-term r and omized , controlled trials to compare functional outcomes of coloplasty , colonic J-Pouch ( JP ) , or a straight anastomosis ( SA ) after the treatment of low rectal cancer . Aim : To compare the complications , long-term functional outcome , and quality of life ( QOL ) of patients undergoing a coloplasty , JP , or an SA in reconstruction of the lower gastrointestinal tract after proctectomy for low rectal cancer . Methods : A multicenter study enrolled patients with low rectal cancer , who were r and omized intraoperatively to coloplasty ( CP-1 ) or SA if JP was not feasible , or JP or coloplasty ( CP-2 ) if a JP was feasible . Patients were followed for 24 months with SF-36 surveys to evaluate the QOL . Bowel function was measured quantitatively and using Fecal Incontinence Severity Index ( FISI ) . Urinary function and sexual function were also assessed . Results : Three hundred sixty-four patients were r and omized . All patients were evaluated for complications and recurrence . Mean age was 60 ±12 years , 71 % were male . Twenty-three ( 7.4 % ) died within 24 months of surgery . No significant difference was observed in the complications among the 4 groups . Two hundred ninety-seven of 364 were evaluated for functional outcome at 24 months . There was no difference in bowel function between the CP-1 and SA groups . JP patients had fewer bowel movements , less clustering , used fewer pads and had a lower FISI than the CP-2 group . Other parameters were not statistically different . QOL scores at 24 months were similar for each of the 4 groups . Conclusions : In patients undergoing a restorative resection for low rectal cancer , a colonic JP offers significant advantages in function over an SA or a coloplasty . In patients who can not have a pouch , coloplasty seems not to improve the bowel function of patients over that with an SA PURPOSE : The colonic J-pouch anastomosis has been advocated to obviate urgent and frequent defecations following a sphincter-saving rectal excision . Physiologic characteristics of the colonic J-pouch were compared with those of the traditional straight anastomosis and related to clinical function . METHOD : Patients with total mesorectal excision for carcinoma were r and omized to either a straight ( n=23 ) or a colonic pouch anastomosis ( n=23 ) . The patients were examined before and at one year after surgery ( n=42 ) , which included laboratory studies , and a question naire regarding anorectal function was completed . RESULTS : Preoperative compliance of the rectum was restored after surgery in the pouch group , 2.9 ( 2.2–3.4 ) ml/cm H2O , but there was a significant decrease after surgery in the straight anastomosis group , 1.9 (1.1–2.3)P<0.001 ( median ( interquartile range ) ) . Sphincter pressures in both groups were similar . In a multiple regression analysis , high compliance was associated with favorable clinical function , and hypermotility of the anal canal was associated with adverse clinical function . CONCLUSIONS : Colonic pouch-anal anastomosis restores neorectal compliance , which is important for good function after low anterior resection . Presence of an unstable internal sphincter is a negative factor for clinical function in both straight and pouch anastomoses PURPOSE : Colonic pouches have gained increasing popularity in reconstruction after low anterior resection . In this prospect i ve , r and omized trial colonic pouch reconstruction is compared with side-to-end anastomosis for functional outcome . METHODS : From October 1995 to October 1996 , 29 patients had colonic pouch and 30 patients had side-to-end anastomosis reconstruction after low anterior resection .  Patients were matched for age , gender , and tumor stage and localization . All patients underwent functional evaluation preoperatively and at three and six months post-operatively . RESULTS : There was no difference in preoperative anorectal function . The operating time was higher in the colonic pouch group ( 167vs . 149 minutes ) . Twenty-three patients ( 79.3 percent ) with colonic pouch had a protective stoma compared with 21 patients ( 70 percent ) with side-to-end anastomosis .  Postoperative complications were 10.3 and 13.3 percent , respectively . There was no difference in manometric pressure of the anus , in anorectal angle , and in continence status after three and six months . Stool frequency was higher in the side-to-end anastomosis group , with 2.2vs . 5.4 per day at three months and 2.3vs . 3.1 per day at six months . Constipation was noted in two patients with colonic pouch ( 7 percent ) and none in the side-to-end anastomosis group at three months and twovs . none at six months . Maximum tolerated volume and threshold volume was higher in the colonic pouch group at three and at six months . CONCLUSION : Both forms of reconstruction have similar satisf 
    Output:
    
Conclusions J-pouch or STEA are acceptable and safe options after AR for rectal cancer .