Modified ileocecal interposition. The final sphincter-saving solution after failed salvage surgery for anastomotic complications of low anterior resection.
BACKGROUND
Reversal of low Hartmann's procedures can be a challenging operation. We report on the successful treatment of patients who have already had prior salvage surgery for complications of a low colorectal anastomosis presenting with active fistulas from the rectal remnant.


METHODS
An ileocolic segment was mobilized with the neurovascular pedicle of the ileocolic artery and turned counterclockwise into the pelvis. The fistulas were cured and a hand-sutured colo-anal anastomosis was performed at the level of the dentate line. Almost the entire length of the remnant colon was preserved.


RESULTS
There was no morbidity. The functional outcome was good or reasonable and the subjective satisfaction with the outcome was very high.


CONCLUSIONS
We conclude that an ileocolic segment is an excellent substitute for reversal of low Hartmann's procedures even in patients in whom prior salvage surgery has failed. As the functional outcome is slightly inferior to other alternatives for rectal replacement, its use should be restricted to patients with complex local situations or in whom alternative reconstructions would result in significant loss of bowel length.
Rink
Andreas D
AD
Department of General Surgery, Leverkusen General Hospital, Leverkusen, Germany. andreas.rink@ukmainz.de
Vestweber
Boris
B
Vestweber
Karl-Heinz
KH
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D001003:Anal Canal; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002432:Cecum / Q000637:transplantation*; D003125:Colostomy / Q000379:methods; D005260:Female; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D016879:Salvage Therapy / Q000009:adverse effects; D016896:Treatment Outcome