What is the functional result of a delayed coloanal anastomosis in redo rectal surgery?. Issue 5 (9th April 2019)

• Record Type: Journal Article
• Authors: Boullenois, Hortense; Lefevre, Jérémie H.; Creavin, Ben; Calmels, Mélanie; Voron, Thibault; Debove, Clotilde; Chafai, Najim; Parc, Yann
• Is Part Of: ANZ journal of surgery. Volume 89:Issue 5(2019)
• Page Start: E179
• Page End: E183
• Publication Date: 2019-04-09
• Subjects: Babcock procedure -- coloanal anastomosis -- delayed anastomosis -- redo surgery; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.15144
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract : Background: Delayed coloanal anastomosis (DCAA) may be used in patients with complex rectal conditions, such as chronic pelvic sepsis, low recto‐vaginal and recto‐vesical fistula; however, limited data are available. The aim is to report the morbidity and functional results of DCAA in redo rectal surgery. Methods: All patients undergoing DCAA between January 2014 and August 2017 were retrospectively included. Success was defined as a functional anastomosis without stoma, evaluated using the Low Anterior Resection Syndrome (LARS) score and the Gastrointestinal Quality of Life Index (GIQLI) functional assessment tools. Results: Of the 72 redo pelvic surgeries, 29 (40.3%) DCAA were performed over a 4‐year period. Indications for redo resection were chronic pelvic sepsis ( n = 13, 44.8%), recto‐vaginal fistula ( n = 11, 37.9%) and recto‐vesical fistula ( n = 5, 17.2%). Mean interval period between the two procedures was 14 ± 3 days (8–21). Global major morbidity (Clavien‐Dindo III or IV) was seen in six patients (20.7%). Stoma closure was feasible for 22 (75.9%) patients after a median period of 78 days (interquartile range 61–98). The 6‐month success rate was 79.3%. Mean LARS was 28.8 ± 10.2 (3–41) (minor LARS) for 18 patients with no stoma at the end of follow‐up. LARS score was significantly better with a follow‐up >2 years (23.3 ± 12.2 versus 32.3 ± 7.9), P = 0.074. Mean GIQLI score was 79.2 ± 14.3 (48–98). Conclusions: Transanal colonic pull through with delayed anastomosis for redo‐surgery in complex pelvic situations had low morbidity and avoided a permanent stoma in three out of four patients with an acceptable quality of life.