“Scarless” and no-stoma surgery for low rectal cancer: the laparoscopic pull-through delayed “high” colo-anal anastomosis

Abstract

Despite recent improvements in surgical technique, low rectal anastomoses for rectal cancer still carry a not negligible incidence of anastomotic leakage and pelvic related morbidity. The Turnball-Cutait delayed colo-anal anastomosis, also referred as pull-through procedure was introduced with the aim to reduce the surgical anastomotic related complications and overcome the need of diverting ileostomy creation. Recently, this technique regained popularity as a viable option not only as salvage procedure after anastomotic failure or in case of hostile pelvis but also as first choice option in case of low rectal cancer. We report our experience with a personal technique for delayed "high" colo-anal anastomosis and its combination with a minimally invasive approach in order to reduce surgical morbidity, avoid the need for stoma creation and minimize the impact of surgery. Between 2011 and 2015, eight consecutive patients were operated for low rectal cancer by the described technique by a minimally invasive approach. The procedure was successfully completed in all cases. Post-operative major morbidity and 60 days mortality were nihil. There was no need for stoma creation or service laparotomy resulting in a virtually "scarless" surgery. Mean cumulative hospital stay (combining the two stages of the procedure) was 7, 6 days (range 7-9). The proposed technique by combining the advantage of a minimally invasive approach to those of a delayed "high" colo-anal anastomoses can be considered a viable option for the surgical treatment of low rectal cancer.

An Old Method Turnbull Cutait; Using for Middle and Distal Rectal Cancer Surgery without Ileostomy. Oncological and Fuctional Late Outcomes

“…1,2 In T-C, there are differences in practice regarding whether the colonic stump tip is left open or closed, how long it should be waited between the stages and how the patient will be fed during this period. 5 In our series, to prevent contamination and the mucous discharge would make it difficult to maintain the colonic stump during the waiting period and the possibility of the colonic motility could negatively affect adhesion, we closed the exteriosed colon end with stapler. The average waiting time between stages was 6 days.…”

“…The presence of diverting ileostomy not only deteriorates the quality of life and poses difficulties in stoma care, but also its reversal requires another operation with 17% surgeryrelated morbidity and 0.4% mortality. 5,10 Despite diverting ileostomy, in the literatüre 8 , the rate of anastomotic leakage was reported between 3 and 20% . Furthermore, not all temporary stomas were reversed, and 3 to 25% of these stomas became permanent.…”

“…Potential candidates for Turnbull-Cutait (T-C) procedure; are reoperated, who have irradiated pelvis with chronic inflammation or infection due to persistant sepsis and as a salvage procedure for complex anorectal conditions as an alternative to permanent stoma creation. 3,4,5 In this study we evaluated the long term outcomes of patients who had T-C procedure due to mid or distal rectal cancer without diverting ileostomy.…”

Ultimate Stomaless Technique of Two-Stage Operation for Lower Rectal Cancer Performed on a Patient with a High Body Mass Index: The Reborn Operation (Novel Pull-Through Method)

“…Nowadays, this two-stage pull-through technique has been reintroduced to prevent the construction of a permanent stoma [4,9,20,21]. In the study by Jarry et al [22], the rate of anastomotic leakage and pelvic abscess was 2 and 6%, respectively, which are both acceptable results.…”

“…There are some issues with stomata even when the diverting ileostomy is created to avoid the anastomotic leakage resulting from low rectal cancer. Diverting ileostomy-related morbidity rates are still nonnegligible, especially in challenging cases [4].…”