Management and results of complications after anterior resection with colonic pouch reconstruction for rectal cancer.
OBJECTIVE
Colonic J-pouch reconstruction is widely carried out during low anterior resection. The aim of this observational study was to describe the complications and evaluate the results of adverse event management.


METHODS
A total of 128 patients underwent an elective anterior resection with colorectal or coloanal J-pouch reconstruction for primary rectal cancer between January 1997 and December 2008.


RESULTS
The overall mortality was 1.6%. Three (2.3%) patients developed pouch necrosis, one of whom died. The rate of anastomotic leakage was 11.7%. Other major complications included intra-abdominal abscess (3.1%), haemorrhage (0.8%) and abdominal dihiscence (0.8%). In all cases of anastomotic leakage, the pouch was salvaged, with 80% of patients undergoing surgical revision with relaparotomy and transanal suture. Patients with pouch necrosis underwent relaparotomy with removal of the pouch and a terminal colostomy. In all cases of intra-abdominal abscess without anastomotic leakage, radiologically controlled percutaneous drainage was carried out.


CONCLUSIONS
Anal function can usually be saved after anastomotic leakage by salvage surgery without increase in mortality.
Kruschewski
M
M
Department of Surgery, Charité- Universitätsmedizin Berlin, Berlin, Germany. martin.kruschewski@charite.de
Gröne
J
J
Vogel
N
N
Zimmermann
M
M
Buhr
H J
HJ
D018784:Abdominal Abscess / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects*; D003125:Colostomy; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D019106:Postoperative Hemorrhage; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects