Coloanal anastomosis for benign lesions: long term functional results in 11 patients.

OBJECTIVE: To assess the indications, morbidity, and long-term functional results of rectal resection and coloanal anastomosis for benign rectal lesions.

DESIGN: Retrospective study.

SETTING: Teaching hospital, France.

SUBJECTS AND INTERVENTIONS: Eleven patients were operated on for villous adenoma (n = 5), radiation proctitis (n = 2), solitary rectal ulcer (n = 2), rectal stenosis (n = 1) and rectovaginal fistula (n = 1).

MAIN OUTCOMES MEASURES: Morbidity, mortality, and long-term results.

RESULTS: There were no postoperative deaths. 2 patients (18%) developed major postoperative complications: one pelvic abscess was treated conservatively and one anastomotic fistula required a diverting colostomy. The mean (SD) follow-up period was 89 (35) months. Functional results were judged as perfect (n = 4), good (n = 1), or acceptable (n = 2) (mean stool frequency: 1.4), including the five with villous adenoma, one with radiation proctitis, and the one with a rectovaginal fistula. By the end of the follow-up period, 4 patients (36%) had permanent colostomies (including the two patients with solitary rectal ulcers). Two of them were required soon after operation, and two following failure 5 and 2 years later, respectively, after initially good functional results.

CONCLUSION: Rectal resection with coloanal anastomosis can safely be proposed for selected patients with benign rectal lesions including diffuse villous adenoma, rectovaginal fistula, and radiation proctitis without deterioration of the anal sphincter. The poor results in the 2 cases of solitary rectal ulcer suggest that for this condition coloanal anastomosis should be done only after the failure of previous surgical treatment.