title: Postoperative and long-term outcomes after redo surgery for failed colorectal or coloanal anastomosis: retrospective analysis of 50 patients and review of the literature.
abstract: BACKGROUND
  Redo surgery for failed colorectal or coloanal anastomosis is a surgical challenge, but despite its technical difficulties and the high associated morbidity risk, it may represent the only valuable option to improve patients' quality of life by avoiding a permanent stoma and decreasing chronic pelvic symptoms.
  
  
  OBJECTIVE
  This study aimed to analyze postoperative and long-term outcomes, with particular focus on functional results, in patients undergoing redo surgery in comparison with previously published studies.
  
  
  METHODS
  This was a retrospective review of prospectively collected data in an institutional database.
  
  
  METHODS
  The study was conducted in the colorectal unit of a tertiary referral teaching hospital in France.
  
  
  METHODS
  Consecutive patients who underwent redo surgery for failed colorectal or coloanal anastomosis from 1998 to 2011 were included.
  
  
  RESULTS
  A total of 50 patients (23 men, 27 women) were included. The median age at redo surgery was 62 years (range, 40-84). Twenty-six patients (52%) underwent a redo colorectal anastomosis and 24 patients a redo coloanal anastomosis (48%). Indications were anastomotic stricture (n = 20), chronic pelvic sepsis (n = 14), rectovaginal fistula (n = 3), prior Hartmann's procedure for complication of initial anastomosis (n = 8), and anastomotic cancer recurrence (n = 5). The median operative time was 435 minutes. Postoperative mortality was 0% and morbidity was 26%. No anastomotic leakage occurred. After a median follow-up of 21 (range, 1-137) months, 44 patients (88%) were evaluated for functional results. The median number of bowel movements per day was 2 (range, 1-10), with 70% of patients having fewer than 3 per day.
  
  
  CONCLUSIONS
  The study was limited by its retrospective nature and lack of data on quality of life.
  
  
  CONCLUSIONS
  Redo surgery for failed colorectal or coloanal anastomosis is a valuable surgical option which allows avoidance of a permanent stoma in nearly 90% of patients. It remains a major undertaking with high intraoperative and postoperative morbidity.
authors: Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery, University Institute of Cancerology, Pierre & Marie Curie University (Paris VI), Paris, France.
authors: Laurent
authors: L
authors: Genser
authors: Gilles
authors: G
authors: Manceau
authors: Mehdi
authors: M
authors: Karoui
authors: Sylvie
authors: S
authors: Breton
authors: Christophe
authors: C
authors: Brevart
authors: Géraldine
authors: G
authors: Rousseau
authors: Jean-Christophe
authors: JC
authors: Vaillant
authors: Laurent
authors: L
authors: Hannoun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D011184:Postoperative Period; D012007:Rectum / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome