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.