What is the functional result of a delayed coloanal anastomosis in redo rectal surgery?
Adult
Aged
Anal Canal
/ surgery
Anastomosis, Surgical
/ methods
Cohort Studies
Colon
/ surgery
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pelvic Inflammatory Disease
/ etiology
Postoperative Complications
/ diagnosis
Proctectomy
/ adverse effects
Quality of Life
Rectal Neoplasms
/ pathology
Rectovaginal Fistula
/ etiology
Reoperation
/ methods
Retrospective Studies
Risk Assessment
Sepsis
/ etiology
Surgical Stomas
Time-to-Treatment
Treatment Outcome
Babcock procedure
coloanal anastomosis
delayed anastomosis
redo surgery
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
31
10
2018
revised:
01
02
2019
accepted:
09
02
2019
pubmed:
11
4
2019
medline:
5
6
2020
entrez:
11
4
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E179-E183Informations de copyright
© 2019 Royal Australasian College of Surgeons.