Chronic rectal anastomosis complications prior to ileostomy reversal: development of a pilot classification system and associated outcomes. Issue 9 (31st May 2022)

• Record Type: Journal Article
• Authors: Taylor, Danielle; Faragher, Ian G.; Master, Mobin; Wang, Stephanie; Chan, Steven T. F.; Yeung, Justin M. C.
• Is Part Of: ANZ journal of surgery. Volume 92:Issue 9(2022)
• Page Start: 2207
• Page End: 2212
• Publication Date: 2022-05-31
• Subjects: anastomotic leak -- anastomotic stenosis -- rectal anastomosis; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.17791
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Backgrounds: A loop ileostomy may reduce the severity of acute anastomotic complications after low rectal resection, but some patients have persistent rectal anastomotic problems. No consensus exists for the management of patients with a chronic low rectal anastomosis complication and a loop ileostomy. There is need for a standard description of these anastomotic complications and to determine whether it is safe to reverse the ileostomy. This study proposes a classification of chronic rectal anastomotic complications and to report the correlation with successful restoration of rectal continuity. Methods: This was a retrospective project from a prospectively maintained database at a single colorectal unit in a large tertiary hospital in Metropolitan Melbourne. Patients with rectal anastomotic complications following rectal cancer resections between March 2012 and October 2019 were included. A classification of chronic rectal anastomotic complication was developed by reviewing the interval assessments of the rectal anastomosis. The classification categories were correlated with outcomes after stoma closure. Results: Of the 149 patients, 20 patients had an anastomotic complication identified during work up prior to loop ileostomy reversal. Eleven patients had an anastomotic stenosis and nine had an anastomotic defect. Eighteen patients were eligible for stomal closure. The majority (11/12) of patients with a Type 1 stenosis or defect had no rectal complications after stoma closure. Conclusion: The classification system helps to describe chronic rectal anastomotic abnormalities and guide management. Although these patients may be a challenge, many can undergo successful ileostomy reversal. Abstract : Patients with a complication of the rectal anastomosis following rectal cancer resection can be difficult to manage. This paper proposes a pilot classification for chronic rectal anastomotic complications and correlates this classification with outcomes after ileostomy reversal.