What is the functional result of a delayed coloanal anastomosis in redo rectal surgery?

Abstract

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%), rectovaginal fistula (n = 11, 37.9%) and recto-vesical fistula (n = 5, 17.2%). Mean interval period between the two procedures was 14 AE 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 AE 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 AE 12.2 versus 32.3 AE 7.9), P = 0.074. Mean GIQLI score was 79.2 AE 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.

Predictive model estimating the decrease of postoperative gastrointestinal quality of life index (GIQLI) in patients after elective laparoscopic sigmoid resection for diverticular disease

“…Actually, the Italian Society of Colon and Rectal Surgery as well as the German Society of Colorectal disease recommend that the central ligation of IMA should be reserved in cases of suspected malignant disease or when the achieved colon mobilization is not enough to have a tension-free anastomosis [17,18]. In the literature, the influence of a high tie dissection of the IMA on QoL was mostly studied in colorectal surgery for cancer [19][20][21][22]. The hypothesis by which the oncological resection could influence the postoperative QoL is based on anatomical reasons.…”

Long‐term functional results and quality of life after redo rectal surgery: delayed versus immediate colo‐anal anastomosis

“…The present study reports on a series of 26 DCAA for redo rectal surgery between January 2014 and August 2018. The authors previously reported a high success rate of DCAA with a low morbidity [8], however, this series showed that functional results evaluated with LARS score seem to be better after ICAA than after DCAA, with no difference in quality of life. All Moreover, evolution of functional disorders after rectal resection is poorly described in the literature, although it seems that function improves with time, even up to two years post-operatively.…”

“…This technique has been described previously. [8] The second operative procedure (colonic stump resection and handsewn redo-surgery with colo-anal anastomosis) was performed by perineal approach approximately 14 days later.…”

“…[6,7] When local factors increase the risk of failure, including chronic pelvic sepsis and very low AF urinary (UF) or vaginal fistula (VF), redo surgery with delayed anastomosis (DCAA) can be utilised. [8] Some authors advocate this anastomosis for almost all redo surgeries. Success of this two-step anastomosis has been recently published but functional results and quality of life of this very low anastomosis, almost a colo-cutaneous anastomosis, are lacking.…”

“…Success of this two-step anastomosis has been recently published but functional results and quality of life of this very low anastomosis, almost a colo-cutaneous anastomosis, are lacking. [8] Published studies include very small sample sizes and mainly consider feasibility and success of this technique.…”