Redo coloanal anastomosis: a retrospective study of 66 patients

Sophie Pitel, Jérémie H Lefèvre, Emmanuel Tiret, Najim Chafai, Yann Parc
Annals of Surgery 2012, 256 (5): 806-10; discussion 810-1

INTRODUCTION: Low colorectal (LCRA) and coloanal anastomoses (CAA) are associated with high leakage rate. After such complication, around 17% of patients remain with their stoma. Treatment of failed LCRA and CAA is not frequently proposed. The aim of this study was to evaluate the results of redo surgery in such patients.

METHODS: Patients who underwent redo surgery between 2000 and 2010 were retrospectively included. Success was defined as a functional anastomosis without diverting stoma. Quality of life and continence were assessed with health survey scoring (SF-12) and Wexner scores.

RESULTS: Sixty-six patients were included, 44 had an LCRA, and 22 had a CAA. Reasons for redo surgery were chronic pelvic abscess (n = 21), rectovaginal fistula (n = 19), strictures (n = 10), prior Hartmann procedures (n = 13), or colovesical fistulas (n = 3). Redo surgery was impossible in 3 patients. Soave's procedure was performed in 27 patients. There were 20 transmesenteric (30.8%) and 5 Deloyers' (7.7%) maneuvers. All patients were diverted. There was no operative mortality. Morbidity rate was 32.3%, 9 patients had to be reoperated. After a median delay of 2.2 months (0.8-121.6), stoma was closed in 56 patients. Forty-six patients were recontacted. Using the SF-12 score, with a median physical health composite scale (PCS) of 48 (28-65) and a median mental health composite scale (MCS) of 52.5 (21-66), quality of life was not altered. Median Wexner score was 8 (0-17); 28% of patients had never experienced incontinence and 60% had fragmentation. With a median follow-up of 35.7 months [range: 0-122.4, 47.9 (±37.8)], 52 patients were cured (78.8%).

CONCLUSIONS: After failed LCRA or CAA, redo anastomosis has a high success rate and acceptable morbidity and function.

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