Clinical Outcomes of a Redo for a Failed Colorectal or Coloanal Anastomosis

Purpose Redo surgery in patients with a persistent anastomotic failure (PAF) is a rare procedure, and data about this procedure are lacking. This study aimed to evaluate the surgical outcomes of redo surgery in such patients. Methods Patients who underwent a redo anastomosis for PAF from January 200...

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Main Authors: In Teak Woo, Jun Seok Park, Gyu-Seog Choi, Soo Yeun Park, Hye Jin Kim, In Kyu Park
Format: Article
Language:English
Published: Korean Society of Coloproctology 2018-10-01
Series:Annals of Coloproctology
Subjects:
Online Access:http://coloproctol.org/upload/pdf/ac-2018-05-04.pdf
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author In Teak Woo
Jun Seok Park
Gyu-Seog Choi
Soo Yeun Park
Hye Jin Kim
In Kyu Park
author_facet In Teak Woo
Jun Seok Park
Gyu-Seog Choi
Soo Yeun Park
Hye Jin Kim
In Kyu Park
author_sort In Teak Woo
collection DOAJ
description Purpose Redo surgery in patients with a persistent anastomotic failure (PAF) is a rare procedure, and data about this procedure are lacking. This study aimed to evaluate the surgical outcomes of redo surgery in such patients. Methods Patients who underwent a redo anastomosis for PAF from January 2004 to November 2016 were retrospectively evaluated. Data from a prospective colorectal database were analyzed. Success was defined as the combined absence of any anastomosis-related complications and a stoma at the last follow-up. Results A total of 1,964 patients who underwent curative surgery for rectal cancer during this study period were included. Among them, 32 consecutive patients underwent a redo anastomosis for PAF. Thirteen patients of those 32 had major anastomotic dehiscence with a pelvic sinus, 12 had a recto-vaginal fistula, and 7 had anastomosis stenosis. There were no postoperative deaths. The median operation time was 255 minutes (range, 80–480 minutes), and the median blood loss was 80 mL (range, 30–1,000 mL). The overall success rate was 78.1%, and the morbidity rate was 40.6%. Multivariable analyses showed that the primary tumor height at the lower level was the only statistically significant risk factor for redo surgery (P = 0.042; hazard ratio, 2.444). Conclusion In our experience, a redo anastomosis is a feasible surgical option that allows closure of a stoma in nearly 80% of patients. Lower tumor height (<5 cm from the anal verge) is the only independent risk factor for nonclosure of defunctioning stomas after primary rectal surgery.
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spelling doaj.art-77ea66bf8a1648feab859813009e78ef2022-12-21T21:49:48ZengKorean Society of ColoproctologyAnnals of Coloproctology2287-97142287-97222018-10-0134525926510.3393/ac.2018.05.041593Clinical Outcomes of a Redo for a Failed Colorectal or Coloanal AnastomosisIn Teak Woo0Jun Seok ParkGyu-Seog Choi1Soo Yeun Park2Hye Jin Kim3In Kyu Park4 Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, KoreaPurpose Redo surgery in patients with a persistent anastomotic failure (PAF) is a rare procedure, and data about this procedure are lacking. This study aimed to evaluate the surgical outcomes of redo surgery in such patients. Methods Patients who underwent a redo anastomosis for PAF from January 2004 to November 2016 were retrospectively evaluated. Data from a prospective colorectal database were analyzed. Success was defined as the combined absence of any anastomosis-related complications and a stoma at the last follow-up. Results A total of 1,964 patients who underwent curative surgery for rectal cancer during this study period were included. Among them, 32 consecutive patients underwent a redo anastomosis for PAF. Thirteen patients of those 32 had major anastomotic dehiscence with a pelvic sinus, 12 had a recto-vaginal fistula, and 7 had anastomosis stenosis. There were no postoperative deaths. The median operation time was 255 minutes (range, 80–480 minutes), and the median blood loss was 80 mL (range, 30–1,000 mL). The overall success rate was 78.1%, and the morbidity rate was 40.6%. Multivariable analyses showed that the primary tumor height at the lower level was the only statistically significant risk factor for redo surgery (P = 0.042; hazard ratio, 2.444). Conclusion In our experience, a redo anastomosis is a feasible surgical option that allows closure of a stoma in nearly 80% of patients. Lower tumor height (<5 cm from the anal verge) is the only independent risk factor for nonclosure of defunctioning stomas after primary rectal surgery.http://coloproctol.org/upload/pdf/ac-2018-05-04.pdfredo surgeryrectal cancerpersistent anastomotic failurelaparoscopy
spellingShingle In Teak Woo
Jun Seok Park
Gyu-Seog Choi
Soo Yeun Park
Hye Jin Kim
In Kyu Park
Clinical Outcomes of a Redo for a Failed Colorectal or Coloanal Anastomosis
Annals of Coloproctology
redo surgery
rectal cancer
persistent anastomotic failure
laparoscopy
title Clinical Outcomes of a Redo for a Failed Colorectal or Coloanal Anastomosis
title_full Clinical Outcomes of a Redo for a Failed Colorectal or Coloanal Anastomosis
title_fullStr Clinical Outcomes of a Redo for a Failed Colorectal or Coloanal Anastomosis
title_full_unstemmed Clinical Outcomes of a Redo for a Failed Colorectal or Coloanal Anastomosis
title_short Clinical Outcomes of a Redo for a Failed Colorectal or Coloanal Anastomosis
title_sort clinical outcomes of a redo for a failed colorectal or coloanal anastomosis
topic redo surgery
rectal cancer
persistent anastomotic failure
laparoscopy
url http://coloproctol.org/upload/pdf/ac-2018-05-04.pdf
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