Remedial Surgery Following Failed Colorectal or Coloanal Anastomosis



Low colorectal (CRA) and coloanal (CAA) anastomosis are associated with early complications such as anastomotic leakage and late complications including chronic anastomotic stricture, leakage and fistula. In these situations, redo surgery with the aim to perform a new CRA or CAA may represent the last surgical option to avoid a permanent stoma. However, these procedures are challenging and technical with potentially high intraoperative and postoperative morbidity. One of the biggest challenges is to bring down a sufficient length of healthy colon in a scarred pelvis to perform a well-vascularized and tension-free anastomosis. The aim of the chapter is to provide abdominal surgeons a general overview of the means to overcome these intraoperative problems and to review the available literature on this particular subject.


Redo surgery Colorectal anastomosis Coloanal anastomosis Deloyers procedure Retroileal Soave procedure 


  1. 1.
    Matthiessen P, Hallbook O, Rutegard J, et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147:339–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Schlegel RD, Dehni N, Parc R, et al. Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum. 2001;44:1464–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Arumainayagam N, Chadwick M, Roe A. The fate of anastomotic sinuses after total mesorectal excision for rectal cancer. Colorectal Dis. 2009;11:288–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Fong SS, Chen K, Sim R. Chronic anastomotic sinus after low anterior resection: when can the defunctioning stoma be reversed? Colorectal Dis. 2011;13:644–9.PubMedCrossRefGoogle Scholar
  6. 6.
    den Dulk M, Smit M, Peeters KC, et al. A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol. 2007;8:297–303.CrossRefGoogle Scholar
  7. 7.
    Lindgren R, Hallbook O, Rutegard J, et al. What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum. 2011;54:41–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Junginger T, Gonner U, Trinh TT, et al. Permanent stoma after low anterior resection for rectal cancer. Dis Colon Rectum. 2010;53:1632–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Garcea G, Sutton CD, Lloyd TD, et al. Management of benign rectal strictures: a review of present therapeutic procedures. Dis Colon Rectum. 2003;46:1451–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Benoist S, Panis Y, Berdah S, et al. New treatment for ileal pouch-anal or coloanal anastomotic stenosis. Dis Colon Rectum. 1998;41:935–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Brehant O, Hanes A, Fuks D, et al. Stapled marsupialisation of chronic low rectal anastomotic sinuses. Int J Colorectal Dis. 2009;24:1233–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Mees ST, Palmes D, Mennigen R, et al. Endo-vacuum assisted closure treatment for rectal anastomotic insufficiency. Dis Colon Rectum. 2008;51:404–10.PubMedCrossRefGoogle Scholar
  13. 13.
    Swain BT, Ellis CN. Fibrin glue treatment of low rectal and pouch-anal anastomotic sinuses. Dis Colon Rectum. 2004;47:253–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Wexner SD, Ruiz DE, Genua J, et al. Gracilis muscle interposition for the treatment of rectourethral, rectovaginal, and pouch-vaginal fistulas: results in 53 patients. Ann Surg. 2008;248:39–43.PubMedCrossRefGoogle Scholar
  15. 15.
    Pitel S, Lefevre JH, Parc Y, et al. Martius advancement flap for low rectovaginal fistula: short- and long-term results. Colorectal Dis. 2011;13:e112–5.PubMedCrossRefGoogle Scholar
  16. 16.
    You YN, Chua HK, Nelson H, et al. Segmental vs. extended colectomy: measurable differences in morbidity, function, and quality of life. Dis Colon Rectum. 2008;51:1036–43.PubMedCrossRefGoogle Scholar
  17. 17.
    Toupet A. Intermediate colectomy with transmesenteric angulo-sigmoid anastomosis. Presse Med. 1961;69:2693–4.PubMedGoogle Scholar
  18. 18.
    Zinzindohoue F. Difficult colo-colonic or colo-rectal anastomoses: trans-mesenteric anastomoses and anastomoses with right colonic inversion. Ann Chir. 1998;52:571–3.PubMedGoogle Scholar
  19. 19.
    Hays LV, Davis DR. A technic for restoring intestinal continuity after left hemicolectomy for cancer of the distal colon and rectum. Am J Surg. 1976;131:390–1.PubMedCrossRefGoogle Scholar
  20. 20.
    Rombeau JL, Collins JP, Turnbull Jr RB. Left-sided colectomy with retroileal colorectal anastomosis. Arch Surg. 1978;113:1004–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Hogan NM, Joyce MR. Retroileal colorectal anastomosis: an old technique, still relevant. Tech Coloproctol. 2014;18:309–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Sileri P, Capuano I, Ciangola CI, et al. Retroileal trans-mesenteric colorectal anastomosis. World J Surg Proced. 2013;3:25–8.CrossRefGoogle Scholar
  23. 23.
    Deloyers L. Suspension of the Right Colon Permits without Exception Preservation of the Anal Sphincter after Extensive Colectomy of the Transverse and Left Colon (Including Rectum). Technic -Indications- Immediate and Late Results. Lyon Chir. 1964;60:404–13.PubMedGoogle Scholar
  24. 24.
    Prevot J. Hirschsprung’s disease: Deloyers’ technic. Ann Chir Infant. 1970;11:81–4.PubMedGoogle Scholar
  25. 25.
    Costalat G, Garrigues JM, Didelot JM, et al. Subtotal colectomy with ceco-rectal anastomosis (Deloyers) for severe idiopathic constipation: an alternative to total colectomy reducing risks of digestive sequelae. Ann Chir. 1997;51:248–55.PubMedGoogle Scholar
  26. 26.
    Bonnard A, de Lagausie P, Leclair MD, et al. Definitive treatment of extended Hirschsprung’s disease or total colonic form. Surg Endosc. 2001;15:1301–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Tang ST, Yang Y, Wang GB, et al. Laparoscopic extensive colectomy with transanal Soave pull-through for intestinal neuronal dysplasia in 17 children. World J Pediatr. 2010;6:50–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Shariff US, Kullar N, Dorudi S. Right colonic transposition technique: when the left colon is unavailable for achieving a pelvic anastomosis. Dis Colon Rectum. 2011;54:360–2.PubMedCrossRefGoogle Scholar
  29. 29.
    Manceau G, Karoui M, Breton S, et al. Right colon to rectal anastomosis (Deloyers procedure) as a salvage technique for low colorectal or coloanal anastomosis: postoperative and long-term outcomes. Dis Colon Rectum. 2012;55:363–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Dumont F, Da Re C, Goere D, et al. Options and outcome for reconstruction after extended left hemicolectomy. Colorectal Dis. 2013;15:747–54.PubMedCrossRefGoogle Scholar
  31. 31.
    Mulsow J, Merkel S, Hohenberger W. Right colonic transposition technique for pelvic anastomosis. Dis Colon Rectum. 2011;54:e245; author reply 245–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Sarli L, Iusco D, Violi V, et al. Subtotal colectomy with antiperistaltic cecorectal anastomosis. Tech Coloproctol. 2002;6:23–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Roncoroni L, Sarli L, Costi R, et al. Caecal-rectal antiperistaltic anastomosis without torsion of the vascular pedicle. Ann Chir. 2000;125:871–3.PubMedCrossRefGoogle Scholar
  34. 34.
    Sarli L, Costi R, Sarli D, et al. Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of chronic slow-transit constipation. Dis Colon Rectum. 2001;44:1514–20.PubMedCrossRefGoogle Scholar
  35. 35.
    Sarli L, Costi R, Iusco D, et al. Long-term results of subtotal colectomy with antiperistaltic cecoproctostomy. Surg Today. 2003;33:823–7.PubMedCrossRefGoogle Scholar
  36. 36.
    Iannelli A, Fabiani P, Mouiel J, et al. Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation. Surg Endosc. 2006;20:171–3.PubMedCrossRefGoogle Scholar
  37. 37.
    Jiang CQ, Qian Q, Liu ZS, et al. Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report. Int J Colorectal Dis. 2008;23:1251–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Feng Y, Jianjiang L. Functional outcomes of two types of subtotal colectomy for slow-transit constipation: ileosigmoidal anastomosis and cecorectal anastomosis. Am J Surg. 2008;195:73–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Marchesi F, Sarli L, Percalli L, et al. Subtotal colectomy with antiperistaltic cecorectal anastomosis in the treatment of slow-transit constipation: long-term impact on quality of life. World J Surg. 2007;31:1658–64.PubMedCrossRefGoogle Scholar
  40. 40.
    Soave F. A new surgical technique for treatment of Hirschsprung’s disease. Surgery. 1964;56:1007–14.PubMedGoogle Scholar
  41. 41.
    Parks AG, Allen CL, Frank JD, et al. A method of treating post-irradiation rectovaginal fistulas. Br J Surg. 1978;65:417–21.PubMedCrossRefGoogle Scholar
  42. 42.
    Chirica M, Parc Y, Tiret E, et al. Coloanal sleeve anastomosis (Soave procedure): the ultimate treatment option for complex rectourinary fistulas. Dis Colon Rectum. 2006;49:1379–83.PubMedCrossRefGoogle Scholar
  43. 43.
    Faucheron JL, Rosso R, Tiret E, et al. Soave’s procedure: the final sphincter-saving solution for iatrogenic rectal lesions. Br J Surg. 1998;85:962–4.PubMedCrossRefGoogle Scholar
  44. 44.
    Broadhurst JF, Lamparelli MJ, Clarke AD, et al. An improved technique for Soave trans-anal pull-through. Colorectal Dis. 2011;13:e83–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Lefevre JH, Bretagnol F, Maggiori L, et al. Redo surgery for failed colorectal or coloanal anastomosis: a valuable surgical challenge. Surgery. 2011;149:65–71.PubMedCrossRefGoogle Scholar
  46. 46.
    Pitel S, Lefevre JH, Tiret E, et al. Redo coloanal anastomosis: a retrospective study of 66 patients. Ann Surg. 2012;256:806–10; discussion 810–1.PubMedCrossRefGoogle Scholar
  47. 47.
    Genser L, Manceau G, Karoui M, et al. Postoperative and long-term outcomes after redo surgery for failed colorectal or coloanal anastomosis: retrospective analysis of 50 patients and review of the literature. Dis Colon Rectum. 2013;56:747–55.PubMedCrossRefGoogle Scholar
  48. 48.
    Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Remzi FH, El Gazzaz G, Kiran RP, et al. Outcomes following Turnbull-Cutait abdominoperineal pull-through compared with coloanal anastomosis. Br J Surg. 2009;96:424–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Olagne E, Baulieux J, de la Roche E, et al. Functional results of delayed coloanal anastomosis after preoperative radiotherapy for lower third rectal cancer. J Am Coll Surg. 2000;191:643–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Digestive and Hepato-Pancreato-Biliary SurgeryPitié Salpêtrière University HospitalParisFrance
  2. 2.Department of Digestive and Hepato-Pancreato-Biliary SurgeryPitié-Salpêtrière University Hospital, Pierre & Marie Curie University (Paris VI)ParisFrance

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