Abstract
Chronic pelvic sepsis eventually requires salvage surgery in half of all patients. The goal of surgery is to resolve pelvic inflammation while restoring intestinal continuity. Our salvage procedure achieves this by bringing a healthy conduit into the pelvis and creating an anastomosis beyond the source of sepsis. We aimed to review our single center experience with this procedure for the treatment of chronic pelvic sepsis. All patients requiring the procedure from 2010 to 2018 were retrospectively reviewed using a prospective database. Morbidity and mortality were evaluated, and restoration of bowel continuity at 1-year rate was the endpoint. Twenty patients were included. The main indication was pelvic sepsis after anastomotic leak (AL). The median age was 60 (42–86) years and the median BMI was 26 (18–37) kg/m2. The median time carrying a stoma before the intervention was 15 months, and median time to intervention was 32 months. All patients had a diverting stoma. There were no death and overall morbidity reached 60%, and AL rate was 10%. At 1 year, 70% of the patients had their intestinal continuity restored. In expert hands, salvage surgery for chronic pelvic sepsis has acceptable morbidity rates, an acceptable rate of AL, and a bowel restoration success rate 70% at 1 year, and is a valuable option for patients failing conservative treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Maggiori L, Blanche J et al (2015) Redo-surgery by transanal colonic pull-through for failed anastomosis associated with chronic pelvic sepsis or rectovaginal fistula. Int J Colorectal Dis 30(4):543–548
Sabbagh C, Maggiori L, Panis Y (2013) Management of failed low colorectal and coloanal anastomosis. J Visc Surg 150(3):181–187
Thomas MS, Margolin DA (2016) Management of colorectal anastomotic leak. Clin Colon Rectal Surg 29(2):138–144
van Koperen PJ et al (2011) The persisting presacral sinus after anastomotic leakage following anterior resection or restorative proctocolectomy. Colorectal Dis 13(1):26–29
Borstlap WAA et al (2018) Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study. Surg Endosc 32(1):315–327
Bloemen JG et al (2009) Long-term quality of life in patients with rectal cancer: association with severe postoperative complications and presence of a stoma. Dis Colon Rectum 52(7):1251–1258
den Dulk M et al (2007) A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol 8(4):297–303
Karim A, Cubas V, Zaman S, Khan S, Patel H, Waterland P et al (2020) Anastomotic leak and cancer-specific outcomes after curative rectal cancer surgery: a systematic review and meta-analysis. Tech Coloproctol 24(6):513–525. https://doi.org/10.1007/s10151-020-02153-5.
Hultman CS et al (2010) Utility of the omentum in pelvic floor reconstruction following resection of anorectal malignancy: patient selection, technical caveats, and clinical outcomes. Ann Plast Surg 64(5):559–562
de Groof EJ et al (2016) Mesenteric tissue for the treatment of septic pelvic complications in the absence of greater omentum. Tech Coloproctol 20(12):875–878
Belli A et al (2018) Reappraisal of pull-through delayed colo-anal anastomosis for surgical treatment of low rectal cancer: do we have to look back to go forward? Ann Laparosc Endosc Surg 3(12):97. https://doi.org/10.21037/ales.2018.12.01
Cutait DE (1970) Prevention of pelvic complications in pull-through operations for cancer and benign lesions. Proc R Soc Med 63(Suppl 1):121–128
Turnbull RB Jr, Cuthbertson A (1961) Abdominorectal pull-through resection for cancer and for Hirschsprung’s disease. Delayed posterior colorectal anastomosis. Cleve Clin Q 28:109–115
Baulieux J, Olagne E, Ducerf C, Adham M, Berthoux N, Bourdeix O, Gérard J (1999) Résultats oncologiques et fonctionnels des résections avec anastomose coloanale directe différée dans les cancers du bas rectum préalablement irradiés. Chirurgie 124:240–251
Deloyers L (1958) Technic permitting the easy assurance of continuity of the colon & conservation of sphincter after excision of the left transverse hemicolon & entire left colon; possible inclusion of rectum. J Chir (Paris) 75(2):147–155
Parks AG (1972) Transanal technique in low rectal anastomosis. Proc R Soc Med 65(11):975–976
Soave F (1964) A new surgical technique for treatment of hirschsprung’s disease. Surgery 56:1007–1014
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Dripps RD (1963) New classification of physical status. Anesthesiology 24:111
van Rooijen SJ et al (2017) Definition of colorectal anastomotic leakage: a consensus survey among dutch and chinese colorectal surgeons. World J Gastroenterol 23(33):6172–6180
Fugazzola P et al (2019) Routine prophylactic ureteral stenting before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: safety and usefulness from a single-center experience. Turk J Urol 45(5):372–376
Marti WR et al (2019) Clinical outcome after rectal replacement with side-to-end, colon-J-pouch, or straight colorectal anastomosis following total mesorectal excision: a swiss prospective, randomized, multicenter trial (SAKK 40/04). Ann Surg 269(5):827–835
Westerduin E et al (2018) Outcome after redo surgery for complicated colorectal and coloanal anastomosis: a systematic review. Dis Colon Rectum 61(8):988–998
Lee SY et al (2018) Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer. Surg Endosc 32(2):660–666
Kraenzler A et al (2017) Anastomotic stenosis after coloanal, colorectal and ileoanal anastomosis: what is the best management? Colorectal Dis 19(2):O90-o96
Acknowledgements
Special thanks to our nursing staff on the ward and our ostomy nurse specialist B. Crispin for taking excellent care of our patients.
Funding
No funds, grants, or other support was received.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ryckx, A., Leonard, D., Bachmann, R. et al. Single center experience with salvage surgery for chronic pelvic sepsis. Updates Surg 74, 1925–1931 (2022). https://doi.org/10.1007/s13304-022-01359-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-022-01359-6