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Outcome After Redo Surgery for Complicated Colorectal and Coloanal Anastomosis

A Systematic Review

Westerduin, Emma, M.D., Ph.D.1,2; Klaver, Charlotte E.L., M.D., Ph.D.2; van Geloven, Anna A.W., M.D., Ph.D.1; Westerterp, Marinke, M.D., Ph.D.3; Bemelman, Willem A., M.D., Ph.D.2; Tanis, Pieter J., M.D., Ph.D.2

Diseases of the Colon & Rectum: August 2018 - Volume 61 - Issue 8 - p 988–998
doi: 10.1097/DCR.0000000000001129
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BACKGROUND: When a colorectal or coloanal anastomosis fails because of persistent leakage or stenosis, or the anastomosis has to be resected for recurrent cancer, constructing a new anastomosis might be an option in selected patients. This is a rare and complex type of redo surgery.

OBJECTIVE: The aim of this review was to evaluate the current literature on redo anastomosis for complicated colorectal or coloanal anastomosis.

DATA SOURCES: A systematic literature search of MEDLINE, EMBASE, the Cochrane Library, the PROSPERO register,, and the World Health Organization International Clinical Trials Registry Platform database was performed.

STUDY SELECTION: Two reviewers independently screened the available literature. All studies reporting on redo surgery and aiming at reconstruction of a prior low colorectal or coloanal anastomosis for any indication were included.

MAIN OUTCOME MEASURES: Primary outcome was successful restoration of continuity. Secondary outcomes were postoperative morbidity, pelvic sepsis, incontinence, and mortality.

RESULTS: Nine studies were included, comprising 291 patients, of whom 76% had index surgery for colorectal cancer. Pooled proportions showed an overall success rate of 79% (95% CI, 69–86), with a pooled incidence of major postoperative morbidity of 16% (95% CI, 10–24). The pooled pelvic sepsis rate was 16% (95% CI, 9–27), and the pooled surgical reintervention and readmission rates were 11% (95% CI, 8–17) and 7% (95% CI, 3–15). Five studies reported on incontinence, with a pooled proportion of 17% (95% CI, 10–26).

LIMITATIONS: The limitations of this review are the lack of randomized controlled trials and high-quality studies, and the small sample sizes and heterogeneous patient populations in the included studies.

CONCLUSIONS: Redo surgery is a valuable treatment option for the complicated colorectal or coloanal anastomosis with 79% successful restoration of bowel continuity in the published literature from experienced tertiary centers.

1 Department of Surgery, Tergooi Hospital, Hilversum, the Netherlands

2 Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands

3 Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands

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Funding/Support: None reported.

Financial Disclosures: None reported.

Correspondence: Pieter J. Tanis, M.D., Ph.D., Department of Surgery, Academic Medical Centre, PO 22660, 1105 AZ Amsterdam, the Netherlands. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons