Second redo surgery after two consecutive failures of a colorectal or coloanal anastomosis: is it reasonable?
| Autor: | Massimo Giacca, Camélia Labiad, Yves Panis, Marie Monsinjon |
|---|---|
| Přispěvatelé: | Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU) |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Reoperation
medicine.medical_specialty Colon Fistula Anal Canal Colorectal anastomosis [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery 030230 surgery Anastomosis Stoma 03 medical and health sciences Postoperative Complications 0302 clinical medicine Internal medicine Humans Medicine Coloanal anastomosis Retrospective Studies Univariate analysis Rectal Neoplasms business.industry Anastomosis Surgical Rectum Gastroenterology Retrospective cohort study [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology Hepatology medicine.disease 3. Good health Surgery Treatment Outcome 030220 oncology & carcinogenesis Redo surgery Colorectal Neoplasms business Chronic pelvic sepsis |
| Zdroj: | International Journal of Colorectal Disease International Journal of Colorectal Disease, Springer Verlag, In press, ⟨10.1007/s00384-021-03982-y⟩ |
| ISSN: | 0179-1958 1432-1262 |
| DOI: | 10.1007/s00384-021-03982-y⟩ |
| Popis: | International audience; Purpose: Colorectal redo surgery is well known to be a difficult procedure, associated with a high risk of failure. The aim of this study was to look into patients presenting two consecutive failed colorectal (CRA) or coloanal (CAA) anastomosis who underwent a second redo surgery (i.e., third anastomosis).Methods: A retrospective study based on a prospective database of second redo surgeries of CRA or CAA, in an expert center. Sixteen patients between 2005 and 2020 were analyzed.Results: After a mean follow-up of 28 ± 26 months, success of surgery (defined as no stoma at the end of follow-up) was reported in 10/16 patients (63%). One patient with chronic anastomotic leakage and another with early colonic ischemia had no defunctioning stoma reversal. In the remaining four patients with a failed second redo surgery, a definitive stoma was ultimately created for fistula recurrence (n = 1), poor functional results (n = 2), or local cancer recurrence (n = 1). Two risk factors for failure of this second redo surgery were significantly found in a univariate analysis: (1) nature of the primary anastomosis: 3/13 s redo surgeries failed (23%) if a CRA was first made and 3/3 (100%) if it was a CAA (p = 0.036); (2) age: patients with a failed second redo surgery were older (p = 0.04).Conclusion: A 63% rate of success of second redo surgery was observed after two failed CRA or CAA. Although a demanding procedure, it can be proposed to carefully selected and motivated patients. |
| Databáze: | OpenAIRE |
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