title: Redo surgery for failed colorectal or coloanal anastomosis: a valuable surgical challenge.
abstract: BACKGROUND
  Redo surgery (RS) in patients with failed anastomosis is a rare procedure, and data about this surgery are lacking. The aim of this study was to examine the operative results and long-term outcomes of RS.
  
  
  METHODS
  All patients who underwent RS between 1999 and 2008 were included. Data were analyzed from a prospective colorectal database. Failure of the procedure was defined as the inability to perform the RS or the inability to close the defunctioning stoma.
  
  
  RESULTS
  Thirty-three patients (22 men) underwent the first surgery at a mean age of 53.4 years. Twenty-four had a colorectal anastomosis (CRA) and nine a coloanal anastomosis (CAA). The reasons for performing RS were stricture (n = 17), prior Hartmann procedure for complication on initial anastomosis (n = 6), chronic fistula (n = 5) or miscellaneous (n = 5). RS was impossible for 2 patients due to extensive adhesions. The mean operating time was 279 min (133-480) and the overall postoperative morbidity rate was 55%. The rate of anastomotic leakage and/or isolated pelvic abscess was 27%. After a mean delay of 3.9 months (0.3-16), 26 patients (79%) had a stoma closure. The mean number of stools per day was 3.2. The failure rates after new handsewn CAA and new stapled CRA were 33% (4/12) and 5% (1/19), respectively (P = .0385). The type of the former anastomosis influenced the success rate of restoring the intestinal continuity: failure rate after prior CAA was 56% and 8% after prior CRA (P = .0031).
  
  
  CONCLUSIONS
  Redo surgery for failure of previous CRA or CAA is feasible but requires a demanding surgical procedure with high short-term morbidity.
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital (APHP), University Paris VII, Paris, France.
authors.forename: Jeremie H
authors.initials: JH
authors.lastname: Lefevre
authors.forename: Frederic
authors.initials: F
authors.lastname: Bretagnol
authors.forename: Leon
authors.initials: L
authors.lastname: Maggiori
authors.forename: Marianne
authors.initials: M
authors.lastname: Ferron
authors.forename: Arnaud
authors.initials: A
authors.lastname: Alves
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000453:epidemiology; D003082:Colectomy / Q000379:methods; D003106:Colon / Q000601:surgery; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D012086:Reoperation / Q000379:methods*; D018570:Risk Assessment; D016019:Survival Analysis