Scarless two-stage delayed coloanal anastomosis: a technique description

Introduction: In current clinical practice, immediate coloanal anastomosis (ICA) remains the standard technique for restoring the gastrointestinal tract following coloproctectomy for low rectal cancer. This anastomosis still requires a temporary diverting stoma to decrease the postoperative morbidity, which remains significantly high. As an alternative, some authors have proposed a two-stage delayed coloanal anastomosis (TS-DCA). This article reports on the surgical technique of TS-DCA. Methods: The case described is of a 53-year-old woman, without any particular history, in whom colonoscopy motivated by rectal bleeding revealed an adenocarcinoma of the low rectum. Magnetic resonance imaging showed a tumor ~ 1 cm above the puborectalis muscle, graded cT3N +. The extension workup was negative. Seven weeks after chemoradiotherapy, a coloproctectomy with total mesorectal excision (TME) was performed. A TS-DCA was chosen to restore the digestive tract. Conclusion: Two-stage delayed coloanal anastomosis is a safe and effective alternative for restoring the digestive tract after proctectomy for low rectal cancer. Recent data seem to show a clear advantage of this technique in terms of morbidity. (AU)

Clinical profile and outcomes of patients undergoing a Turnbull-Cutait transanal pullthrough procedure with Delayed Coloanal Anastomosis (DCAA) at the Philippine General Hospital

RATIONALE/OBJECTIVES@#The Turnbull-Cutait transanal pullthrough procedure with delayed coloanal anastomosis has been widely used before the advent of intestinal stapling devices. It is a viable option for rectal reconstruction for benign and malignant conditions, and is able to maintain intestinal continuity without the use of a temporary diversion. It has also been used in salvage operations for pelvic sepsis, failed anastomosis, and tumor recurrence that will otherwise require a permanent ileostomy. This study will describe the technique, as well as the outcomes of patients who underwent the procedure.@*METHODS@#This is a retrospective descriptive study conducted to report the outcomes of patients who underwent the Turnbull-Cutait transanal pull-through with delayed coloanal anastomosis at the Philippine General Hospital from January 2008 to December 2013. Eleven patients were identified using an institutional retrospective database. Clinical data and outcomes were collected using a standard form.@*RESULTS@#Ten of the 11 patients had an unremarkable postoperative course. One patient had an anastomotic dehiscence. The mean operative time was 229.9 minutes for the 1st stage and 28.2 minutes for the second stage, with a mean blood loss of 463.6 cc for both stages. The mean interval between the two stages was 7.9 days, with an average postoperative length of stay of 8.27 days. The average follow-up was 4.5 years. Functional outcomes were acceptable (average Wexner score 5.63), except for one patient who had an anastomotic dehiscence. No perioperative mortality was noted.@*CONCLUSION@#Turnbull-Cutait trans-anal pullthrough procedure with delayed coloanal anastomosis appears to be a safe procedure. The study suggests that it is an alternative strategy in rectal cancer in providing a sphincter-saving surgery, with the establishment of gastrointestinal continuity, and without the need for a proximal diversion. Stoma-less surgery has a notable health economic impact especially in developing countries because it eliminates the costs associated with the use of stoma appliances.

A combination treatment of transanal total mesorectal excision and Turnbull-Cutait abdominoperineal pull-through procedure for a low rectal cancer

ABSTRACT Surgical treatment for low rectal cancer has changed dramatically during the preceding several decades, and the optimal surgical approach remains incompletely developed. Transanal total mesorectal excision is likely the most promising approach for the dissection of the distal part of the mesorectum in a manner that allows for a technically easy and oncologically safe operation. Long after it was first described, the Turnbull-Cutait abdominoperineal pull-through procedure has recently been reintroduced in surgical practice for the treatment of patients with complex anorectal conditions. The current report describes a case of distal rectal cancer involving successful surgical treatment with a combination of the two aforementioned methods and patient discharge without a diverting stoma.

RESUMO tratamento cirúrgico para o câncer de reto baixo mudou drásticamente durante as últimas décadas, mas uma abordagem cirúrgica de excelência ainda continua incompletamente desenvolvida. A excisão total do mesorreto por via transanal parece ser a abordagem mais promissora para a dissecção da parte distal do mesorreto de forma a assegurar uma cirurgia oncológicamente segura com uma técnica simples. Muito depois de sua descrição, o pull-through abdominoperineal de Turnbull-Cutait tem sido reintroduzido na prática cirúrgica para o tratamento de pacientes com enfermidades anorretais complexas. Este relato descreve um caso de câncer de reto baixo que se beneficiou de um tratamento cirúrgico bem sucedido a partir da combinação das duas técnicas supracitadas com o paciente recebendo alta hospitalar sem ostomia de proteção.