TY - JOUR
T1 - Salvage abdominal surgery in patients with a retained rectal stump after restorative proctocolectomy and stapled anastomosis
AU - Tulchinsky, H.
AU - McCourtney, J. S.
AU - Subba Rao, K. V.
AU - Chambers, W.
AU - Williams, J.
AU - Wilkinson, K. H.
AU - Nicholls, R. J.
PY - 2001
Y1 - 2001
N2 - Background: The introduction of surgical stapling instruments has widened the use of restorative proctocolectomy. Too high a distal transection of the rectum can, however, produce a retained rectal stump, which may cause symptoms. A study of the operative and functional data in a consecutive series of patients undergoing salvage surgery for retained rectal stump was undertaken. Methods: Twenty-five patients referred between January 1990 and September 2000 for pouch dysfunction were identified as having a retained rectal stump. Twenty-two underwent abdominoanal revision. The hospital notes were reviewed and function was assessed during outpatient visits, by postal questionnaire and by telephone interview. Results: Median operating time was 225 (range 170-340) min and median hospital stay was 15 (range 8-48) days. There was no operative death. Five pouches were excised. Seventeen patients were available for functional assessment. Median follow-up was 22.5 (range 4-114) months. Median 24-h frequency before and after operation was 12 (range 4-20) and 6 (range 3-12) respectively, and median night-time frequency was 4 (range 0-8) and 0-5 (range 0-4) respectively. Fifteen patients reported marked subjective improvement in pouch function and quality of life. Conclusion: Major revisional surgery for symptomatic retained rectal stump after restorative proctocolectomy with stapled anastomosis was successful in 15 of 22 patients. These results are worse than the outcome following first-time restorative proctocolectomy with anastomosis constructed at the anal level. Pouch-rectal anastomosis should be avoided.
AB - Background: The introduction of surgical stapling instruments has widened the use of restorative proctocolectomy. Too high a distal transection of the rectum can, however, produce a retained rectal stump, which may cause symptoms. A study of the operative and functional data in a consecutive series of patients undergoing salvage surgery for retained rectal stump was undertaken. Methods: Twenty-five patients referred between January 1990 and September 2000 for pouch dysfunction were identified as having a retained rectal stump. Twenty-two underwent abdominoanal revision. The hospital notes were reviewed and function was assessed during outpatient visits, by postal questionnaire and by telephone interview. Results: Median operating time was 225 (range 170-340) min and median hospital stay was 15 (range 8-48) days. There was no operative death. Five pouches were excised. Seventeen patients were available for functional assessment. Median follow-up was 22.5 (range 4-114) months. Median 24-h frequency before and after operation was 12 (range 4-20) and 6 (range 3-12) respectively, and median night-time frequency was 4 (range 0-8) and 0-5 (range 0-4) respectively. Fifteen patients reported marked subjective improvement in pouch function and quality of life. Conclusion: Major revisional surgery for symptomatic retained rectal stump after restorative proctocolectomy with stapled anastomosis was successful in 15 of 22 patients. These results are worse than the outcome following first-time restorative proctocolectomy with anastomosis constructed at the anal level. Pouch-rectal anastomosis should be avoided.
UR - http://www.scopus.com/inward/record.url?scp=0035212691&partnerID=8YFLogxK
U2 - 10.1046/j.0007-1323.2001.01931.x
DO - 10.1046/j.0007-1323.2001.01931.x
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C2 - 11736972
AN - SCOPUS:0035212691
VL - 88
SP - 1602
EP - 1606
JO - British Journal of Surgery
JF - British Journal of Surgery
SN - 0007-1323
IS - 12
ER -