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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Korean Society of Coloproctology
2018-10-01
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Series: | Annals of Coloproctology |
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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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issn | 2287-9714 2287-9722 |
language | English |
last_indexed | 2024-12-17T12:01:50Z |
publishDate | 2018-10-01 |
publisher | Korean Society of Coloproctology |
record_format | Article |
series | Annals of Coloproctology |
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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