The purpose of this article is to review the different aspects of the colonic J-pouch reconstruction with special focus on functional results and complications. A MEDLINE search from 1965 to the present with manual search for older articles was used as the basis of this review. Rectal reconstruction using a colonic J-pouch-anal anastomosis after excision of extraperitoneal cancers can be performed with acceptable morbidity and good functional results. Among the different methods of rectal reconstruction now available after total rectal resection for cancer, the colonic J-pouch may be the optimal choice.