title: Redo coloanal anastomosis: a retrospective study of 66 patients.
abstract: BACKGROUND
  Low colorectal (LCRA) and coloanal anastomoses (CAA) are associated with high leakage rate. After such complication, around 17% of patients remain with their stoma. Treatment of failed LCRA and CAA is not frequently proposed. The aim of this study was to evaluate the results of redo surgery in such patients.
  
  
  METHODS
  Patients who underwent redo surgery between 2000 and 2010 were retrospectively included. Success was defined as a functional anastomosis without diverting stoma. Quality of life and continence were assessed with health survey scoring (SF-12) and Wexner scores.
  
  
  RESULTS
  Sixty-six patients were included, 44 had an LCRA, and 22 had a CAA. Reasons for redo surgery were chronic pelvic abscess (n = 21), rectovaginal fistula (n = 19), strictures (n = 10), prior Hartmann procedures (n = 13), or colovesical fistulas (n = 3). Redo surgery was impossible in 3 patients. Soave's procedure was performed in 27 patients. There were 20 transmesenteric (30.8%) and 5 Deloyers' (7.7%) maneuvers. All patients were diverted. There was no operative mortality. Morbidity rate was 32.3%, 9 patients had to be reoperated. After a median delay of 2.2 months (0.8-121.6), stoma was closed in 56 patients. Forty-six patients were recontacted. Using the SF-12 score, with a median physical health composite scale (PCS) of 48 (28-65) and a median mental health composite scale (MCS) of 52.5 (21-66), quality of life was not altered. Median Wexner score was 8 (0-17); 28% of patients had never experienced incontinence and 60% had fragmentation. With a median follow-up of 35.7 months [range: 0-122.4, 47.9 (±37.8)], 52 patients were cured (78.8%).
  
  
  CONCLUSIONS
  After failed LCRA or CAA, redo anastomosis has a high success rate and acceptable morbidity and function.
authors.affiliation: Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris VI, 184 rue du Faubourg Saint-Antoine, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Pitel
authors.forename: Jérémie H
authors.initials: JH
authors.lastname: Lefèvre
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tiret
authors.forename: Najim
authors.initials: N
authors.lastname: Chafai
authors.forename: Yann
authors.initials: Y
authors.lastname: Parc
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000453:epidemiology / Q000401:mortality; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods* / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D020127:Recovery of Function; D012002:Rectal Diseases / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome