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Review
. 2023 Oct;39(5):375-384.
doi: 10.3393/ac.2022.00605.0086. Epub 2022 Dec 20.

Outcomes of redo for failed colorectal or coloanal anastomoses: a systematic review and meta-analysis

Ricardo Purchio Galletti  1 , Gabriel Andrade Agareno  1 , Lucas de Abreu Sesconetto  1 , Rafael Benjamim Rosa da Silva  1 , Rafael Vaz Pandini  1 , Lucas Soares Gerbasi  1 , Victor Edmond Seid  1 , Sérgio Eduardo Alonso Araujo  1 , Francisco Tustumi  1
Affiliations
Review

Outcomes of redo for failed colorectal or coloanal anastomoses: a systematic review and meta-analysis

Ricardo Purchio Galletti et al. Ann Coloproctol. 2023 Oct.

Abstract

Purpose: This study aimed to review the outcomes of redo procedures for failed colorectal or coloanal anastomoses.

Methods: A systematic review was performed using the PubMed, Embase, Cochrane, and LILACS databases. The inclusion criteria were adult patients undergoing colectomy with primary colorectal or coloanal anastomosis and studies that assessed the postoperative results. The protocol is registered in PROSPERO (No. CRD42021267715).

Results: Eleven articles met the eligibility criteria and were selected. The studied population size ranged from 7 to 78 patients. The overall mortality rate was 0% (95% confidence interval [CI], 0%-0.01%). The postoperative complication rate was 40% (95% CI, 40%-50%). The length of hospital stay was 13.68 days (95% CI, 11.3-16.06 days). After redo surgery, 82% of the patients were free of stoma (95% CI, 75%-90%), and 24% of patients (95% CI, 0%-39%) had fecal incontinence. Neoadjuvant chemoradiotherapy (P=0.002) was associated with a lower probability of being free of stoma in meta-regression.

Conclusion: Redo colorectal and coloanal anastomoses are strategies to restore colonic continuity. The decision to perform a redo operation should be based on a proper evaluation of the morbidity and mortality risks, the probability of remaining free of stoma, the quality of life, and a functional assessment.

Keywords: Colorectal neoplasms; Colorectal surgery; Reoperation; Surgical anastomosis.

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Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was re­ported.

Figures

Fig. 1.
Fig. 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart.
Fig. 2.
Fig. 2.
Postoperative mortality. CI, confidence interval; REML, restricted maximum likelihood.
Fig. 3.
Fig. 3.
Postoperative complications. CI, confidence interval; REML, restricted maximum likelihood.
Fig. 4.
Fig. 4.
Length of hospital stay. CI, confidence interval.
Fig. 5.
Fig. 5.
Incontinence. CI, confidence interval; REML, restricted maximum likelihood.
Fig. 6.
Fig. 6.
Freedom from stoma at the end of follow-up. CI, confidence interval; REML, restricted maximum likelihood.
Fig. 7.
Fig. 7.
Bubble plot. Meta-regression was used to identify covariates that could influence the outcomes. (A) Proportion of patients who received neoadjuvant therapy. (B) Mean age. (C) Redo surgery technique: immediate versus delayed anastomosis (pull-through). CI, confidence interval.
See this image and copyright information in PMC

References

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