Postoperative and long-term outcomes after redo surgery for failed colorectal or coloanal anastomosis: retrospective analysis of 50 patients and review of the literature.

Abstract

INTRODUCTION:

Redo surgery for failed colorectal or coloanal anastomosis is a surgical challenge, but despite its technical difficulties and the high associated morbidity risk, it may represent the only valuable option to improve patients' quality of life by avoiding a permanent stoma and decreasing chronic pelvic symptoms.

OBJECTIVES:

This study aimed to analyze postoperative and long-term outcomes, with particular focus on functional results, in patients undergoing redo surgery in comparison with previously published studies.

DESIGN:

This was a retrospective review of prospectively collected data in an institutional database.

SETTING:

The study was conducted in the colorectal unit of a tertiary referral teaching hospital in France.

PATIENTS:

Consecutive patients who underwent redo surgery for failed colorectal or coloanal anastomosis from 1998 to 2011 were included.

RESULTS:

A total of 50 patients (23 men, 27 women) were included. The median age at redo surgery was 62 years (range, 40-84). Twenty-six patients (52%) underwent a redo colorectal anastomosis and 24 patients a redo coloanal anastomosis (48%). Indications were anastomotic stricture (n = 20), chronic pelvic sepsis (n = 14), rectovaginal fistula (n = 3), prior Hartmann's procedure for complication of initial anastomosis (n = 8), and anastomotic cancer recurrence (n = 5). The median operative time was 435 minutes. Postoperative mortality was 0% and morbidity was 26%. No anastomotic leakage occurred. After a median follow-up of 21 (range, 1-137) months, 44 patients (88%) were evaluated for functional results. The median number of bowel movements per day was 2 (range, 1-10), with 70% of patients having fewer than 3 per day.

LIMITATION:

The study was limited by its retrospective nature and lack of data on quality of life.

CONCLUSIONS:

Redo surgery for failed colorectal or coloanal anastomosis is a valuable surgical option which allows avoidance of a permanent stoma in nearly 90% of patients. It remains a major undertaking with high intraoperative and postoperative morbidity.

• Authors: Laurent Genser, Gilles Manceau, Mehdi Karoui, Sylvie Breton, Christophe Brevart, Géraldine Rousseau, Jean-Christophe Vaillant, Laurent Hannoun
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 56 Issue 6 Pg. 747-55 (Jun 2013) ISSN: 1530-0358 [Electronic] United States
• PMID: 23652749 (Publication Type: Journal Article, Review)

Topics

• Adult
• Aged
• Aged, 80 and over
• Anal Canal (surgery)
• Anastomosis, Surgical (adverse effects, methods)
• Colon (surgery)
• Female
• Humans
• Male
• Middle Aged
• Morbidity
• Postoperative Complications (epidemiology, surgery)
• Postoperative Period
• Rectum (surgery)
• Reoperation (statistics & numerical data)
• Retrospective Studies
• Treatment Outcome