Abstract
The aim was to report our experience with delayed colo-anal anastomosis (DCA) to avoid permanent stoma for complex rectal cases evaluating short- and long-term outcomes. Nine patients who underwent DCA from 2011 to 2016 were collected and analysed case by case. We considered medical history and surgical outcomes. Long-term bowel function was evaluated using the Wexner and low anterior resection syndrome (LARS) score at 6, 12 and 24 months. The range from previous surgery and salvage procedure was 337 days. All cases were performed with a full laparoscopic approach. The median length of hospital stay was 15 days. The median follow-up was 970.5 days. There was no peri-operative mortality. Two patients developed a post-operative pelvic abscess that required redo surgery. Long-term post-operative complications were mucosal prolapsed, anastomosis retraction and anastomotic stricture. The average values of LARS and Wexner scores were, respectively, at 6 months 33.7 and 16.2, at 12 months 28.5 and 11.7, at 24 months 21.1 and 6.7. Colo-anal sleeve delayed anastomosis appears a real answer to avoid permanent stoma in selected patients. The laparoscopic procedure is safe and feasible for skilful mini-invasive surgeons. Our experience describes the complexity of clinical history of these patients underlying a slow, but progressive improvement in continence after restoration of bowel continuity.
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References
Gazet JC (1985) Parks’ coloanal pull-through anastomosis for severe, complicated radiation proctitis. Dis Colon Rectum 28:110–114
Nowacki MP (1991) Ten years of experience with Parks’ coloanal sleeve anastomosis for the treatment of post-irradiation rectovaginal fistula. Eur J Surg Oncol 17:563–566
Patsouras D, Yassin NA, Phillips RK (2014) Clinical outcomes of colo-anal pull-through procedure for complex rectal conditions. Colorectal Dis 16:253–258
Faucheron JL, Rosso R, Tiret E, Keli E, Nugent KP, Frileux P, Park R (1998) Soave’s procedure: the final sphincter-saving solution for iatrogenic rectal lesions. Br J Surg 85:962–964
Maxwell-Armstrong CA, Phillips RK (2003) Extrasphincteric rectal fistulas treated successfully by Soave’s procedure despite marked local sepsis. Br J Surg 90:237–238
Veenhof AA, van der Peet DL, Sietses C, Cuesta MA (2007) Pull-through procedure as treatment for coloanal anastomotic dehiscence following laparoscopic total mesorectal excision. Int J Colorectal Dis 22:1413–1414
Remzi FH, El Gazzaz G, Kiran RP, Kirat HT, Fazio VW (2009) Outcomes following Turnbull–Cutait abdominoperineal pull-through compared with coloanal anastomosis. Br J Surg 96:424–429
Hallet J, Bouchard A, Drolet S, Milot H, Desrosiers E, Lebrun A, Grégoire RC (2014) Anastomotic salvage after rectal cancer resection using the Turnbull–Cutait delayed anastomosis. Can J Surg 57:405–411
Maggiori L, Blanche J, Harnoy Y, Ferron M, Panis Y (2015) Redo-surgery by transanal colonic pull-through for failed anastomosis associated with chronic pelvic sepsis or rectovaginal fistula. Int J Colorectal Dis 30:543–548
Turnbull RB Jr, Cuthbertson A (1961) Abdominorectal pull-through resection for cancer and for Hirschsprung’s disease. Delayed posterior colorectal anastomosis. Clevel Clin Q 28:109–115
Cutait DE, Figliolini FJ (1961) A new method of colorectal anastomosis in abdominoperineal resection. Dis Colon Rectum 4:335–342
Parks A (1972) Transanal technique in low rectal anastomosis. Proc R Soc 65:975–976
Soave F (1964) A new surgical technique for treatment of Hirschsprung’s disease. Surgery 56:1007–1014
Zbar A (2014) The colo-anal pull-through procedure. Colorectal Dis 16(11):925
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Emmertsen KJ, Laurberg S (2012) Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 255:922–928
Prete F, Prete FP (2013) The pull-through: back to the future. G Chir 34:293–301
Bianco F, Belli A, De Franciscis S, Falato A, Romano GM (2016) “Scarless” and no-stoma surgery for low rectal cancer: the laparoscopic pull-through delayed “high” colo-anal anastomosis. Updates Surg 68:99–104
Deloyers L (1964) Suspension of the right colon permits without exception preservation of the anal sphincter after extensive colectomy of the transverse and left colon (including rectum), technic-indications-immediate and late results. Lyon Chir 60:404–413
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Barugola, G., Bertocchi, E., Gentile, I. et al. Hostile pelvis: how to avoid permanent stoma. Updates Surg 70, 459–465 (2018). https://doi.org/10.1007/s13304-018-0555-z
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DOI: https://doi.org/10.1007/s13304-018-0555-z