Clinical outcomes of colo‐anal pull‐through procedure for complex rectal conditions. (April 2014)

• Record Type: Journal Article
• Authors: Patsouras, D.; Yassin, N. A.; Phillips, R. K. S.
• Is Part Of: Colorectal disease. Volume 16:Number 4(2014)
• Page Start: 253
• Page End: 258
• Publication Date: 2014-04
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.12532
• Languages: English
• ISSNs: 1462-8910

Abstract

<abstract abstract-type="main" id="codi12532-abs-0001"> <title>Abstract</title> <sec id="codi12532-sec-0001" sec-type="section"> <title>Aim</title> <p>Pull‐through with colo‐anal sleeve anastomosis may be used as a last resort to avoid permanent diversion in patients with complex rectal conditions. This procedure allows the preservation of intestinal continuity by minimizing the hazards of deep dissection in an inflamed and fibrosed pelvis.</p> </sec> <sec id="codi12532-sec-0002" sec-type="section"> <title>Method</title> <p>A retrospective study was performed of colo‐anal pull‐through procedures carried out between January 1998 and December 2012 at St Mark's Hospital by one surgeon. Patients were identified from operative logbooks and their case notes were reviewed. Thirty‐four patients (21 women) with a median age of 54 (21–75) years underwent the pull‐through operation for complex rectal conditions involving fistulae and/or a hostile pelvis as a final attempt to restore intestinal continuity.</p> </sec> <sec id="codi12532-sec-0003" sec-type="section"> <title>Results</title> <p>The median length of hospital stay was 7.5 (5–45) days. Median follow‐up was 23 (3–71) months. There was no peri‐operative mortality. There were two (6%) outright failures. Early complications occurred in 14 (41%) patients and late complications in 10 (29%). Fistulae recurred in seven (25%) of 28 patients but with further treatment four healed, giving an overall healing rate of 89%. Normal continence was achieved in 19 (79%) of 24 patients who were evaluated.</p> </sec> <sec id="codi12532-sec-0004" sec-type="section"> <title>Conclusion</title> <p>In clinically difficult rectal situations the colo‐anal pull‐through procedure is a suitable salvage procedure to restore intestinal continuity before considering a permanent stoma.</p> </sec> </abstract>