BACKGROUND Low anterior resection, colo-anal anastomosis with anal sphincters preservation has become the routine procedure for the treatment of low rectal cancer. This method avoids the need for a permanent colostomy without compromising oncological principles. However, many of these patients experience symptoms of fecal frequency, urgency and variable degree of incontinence. Improvement with the functional results has been reported in patients in whom continuity has been restored by means of colonic j pouch. OBJECTIVE To compare the outcome of anterior resection and colonic pouch anal anastomosis (CPAA) with the conventional straight coloanal anastomosis (SCAA). METHODS The files of patients who underwent anterior resection with CPAA or SCAA between 1994-2001 were analyzed retrospectively. Patients filled out an updated questionnaire regarding their functional outcome. RESULTS Thirty nine patients underwent CPAA and 42 SCAA. Mean follow-up was 31 months. There was no perioperative mortality and the rate of complications was similar in the two groups. Bowel movements per 24 hours were 4.2 and 6 in the CPAA and the SCCA groups respectively. The bowel movements during night were 0.4 and 1.5 respectively. Sixty percent of patients after CPAA had 3 or less bowel movements per 24 hours as compared to 44% of patients after SCAA. Continence scores were 3.9 and 3.5 in patients after CPAA and SCAA respectively. Seventy two percent of patients after CPAA reported continence scores of 4 or more as compared to only 51% of patients in the SCAA group. CONCLUSIONS Our results confirm previous reports that anterior resection and CPAA improves the functional outcome and quality of life after sphincter saving operation for low rectal cancer.