• Laurent Genser, Gilles Manceau, Mehdi Karoui, Sylvie Breton, Christophe Brevart, Géraldine Rousseau, Jean-Christophe Vaillant, and Laurent Hannoun.
• 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.
• Dis. Colon Rectum. 2013 Jun 1;56(6):747-55.

IntroductionRedo 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.ObjectivesThis 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.DesignThis was a retrospective review of prospectively collected data in an institutional database.SettingThe study was conducted in the colorectal unit of a tertiary referral teaching hospital in France.PatientsConsecutive patients who underwent redo surgery for failed colorectal or coloanal anastomosis from 1998 to 2011 were included.ResultsA 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.LimitationThe study was limited by its retrospective nature and lack of data on quality of life.ConclusionsRedo 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.

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