***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 
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    Input: Background Functional outcome after rectal excision with coloanal anastomosis  is improved by construction of a colonic J pouch . Present prospect i ve r and omized studies lack follow‐up beyond 1 year . The aim of this study was to assess the clinical outcome at both short‐ and long‐term follow‐UP 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 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 Objectives The introduction of the colonic J‐pouch has markedly improved the functional outcome of restorative rectal cancer surgery . However colonic J‐pouch surgery can be problematic and may present some late evacuatory problems . To overcome these limitations a novel pouch has been proposed : the transverse coloplasty pouch . The purpose of our study was to compare the functional outcomes of these two different types of pouches – the transverse coloplasty pouch ( TCP ) and the colonic J‐pouch ( CJP ) – during the first 12 months postoperatively OBJECTIVE The authors compared clinical bowel function and complications of a  low anterior resection with either a straight or colonic J pouch anastomosis . SUMMARY BACKGROUND DATA Urgency and frequent bowel movements after rectal resection with a low anastomosis have been related to the loss of rectal reservoir function . Reconstruction with a colonic J pouch possibly can obviate some of this dysfunction . Earlier reports have been favorable , but they must be verified in r and omized trials . METHOD One hundred patients with rectal cancer in whom a sphincter-saving procedure was appropriate were r and omized to reconstruction  with either a straight or a colonic J pouch anastomosis . RESULTS The incidence of symptomatic anastomotic leakage was lower in the pouch group ( 2 % vs. 15 % , p = 0.03 ) . Eighty-nine patients could be evaluated after 1 year . The pouch patients had significantly fewer bowel movements per 24 hours , and less nocturnal evacuations , urgency , and incontinence . Overall well-being owing to the bowel function was rated significantly higher by the pouch patients . CONCLUSION Reconstruction with a colonic J pouch was associated with a lower incidence of anastomotic leakage and better clinical bowel function when compared with the traditional straight anastomosis . Functional superiority was especially evident during the first 2 months Twenty patients ( 13 men ) with low rectal cancer , median ( range ) age 64.5 ( 38–83 ) years were prospect ively r and omized to undergo ultra‐low anterior resection with a J colonic pouch‐anal anastomosis ( median ( range ) distance of anastomosis from the anal verge 3 ( 1–4 ) cm ) . Another 20 patients ( 15 men ) , median ( range ) age 62.5 ( 44–86 ) years ) with low rectal cancer were r and omized to a straight coloanal anastomosis ( median ( range ) distance of anastomosis from the anal verge 3.25 ( 2–5 ) cm ) . There were no significant differences in operative time or complications between the two groups . There was significantly better postoperative anal function in patients who underwent pouch‐anal anastomosis at 1 , 6 and 12 months after ileostomy closure . At 12 months all patients ( 19 of 19 ) with a pouch reconstruction had regained normal continence compared with 14 of 20 of those who had a straight coloanal anastomosis . No patient complained of severe constipation requiring enema or intubation to evacuate Abstract BACKGROUND : Low anterior resection with coloanal anastomosis prevents a definitive stoma in patients with distal rectal cancer . However , imperative stool urge , stool fragmentation , prolonged stooling sessions , and minor problems of incontinence are frequently observed in the postoperative situation and negatively affect quality of life . Therefore , the colonic J-pouch was originally constructed to create a stool reservoir . In a r and omized , prospect i ve study , the short ( 5 cm ) colonic J-pouch was tested for function and continence vs. straight coloanal anastomosis . METHODS : Over a period of 30 months , 74 consecutive patients ( 55 males ) with rectal cancer in the lower and middle third of the rectum were included and r and omized into two groups . Anastomosis was performed either as a coloanal or a colon-pouch-anal anastomosis . The st and ardized surgical procedure included mobilization of the left hemicolon , central ligation of the inferior mesenteric artery and vein , preaortal lymph node dissection , autonomic nerve preservation , and total mesorectal excision . The anastomosis was performed at the upper anal canal or at the intersphincteric level . All patients were evaluated preoperatively and six months postoperatively for fecal continence , including sphincter manometry and defecation habits . In addition , quality of life was determined by use of a st and ardized question naire ( European Organization for Research and Treatment of Cancer , EORTC-QLQ-C30 ) . RESULTS : Thirty-seven patients were r and omized into each group . In general , problems with continence for liquids or gas occurred less frequently in the colonic J-pouch group 6 months after surgery . The frequency of bowel movements was lower in the J-pouch group ( 2.5 per day ) than in the coloanal group ( 4.7 per day ) . Importantly , in a manometric study at the same postoperative point , neorectal capacity was decreased to a similar degree in both groups compared with the preoperative rectal volume . Thus , the expected and postulated reservoir effect could not be achieved by forming a 5-cm colonic J-pouch . CONCLUSION : The colonic J-pouch was superior with regard to continence for gas and liquids compared with a straight coloanal anastomosis . Furthermore , stool frequency was significantly lower in the J-pouch group than in the coloanal reconstruction group . However , because neorectal capacity decreased equally in both groups , we speculate that the advantage of the colonic 
    Output:
    
Colonic J pouch was associated with lower stool frequency and antidiarrhoeal medication use for up to 1 year after surgery compared with straight CAA .
Transverse coloplasty and side-to-end CAA had similar functional outcomes to the colonic J pouch .
No superiority was found for any of the techniques in terms of anastomotic leak rate .
CONCLUSION Colonic J pouch and side-to-end CAA or transverse coloplasty lead to a better functional outcome than straight CAA for the first year after surgery