Ann Coloproctol.  2023 Oct;39(5):375-384. 10.3393/ac.2022.00605.0086.

Outcomes of redo for failed colorectal or coloanal anastomoses: a systematic review and meta-analysis

• Galletti RP
• Agareno GA
• Sesconetto LdA
• Silva RBRd
• Pandini RV
• Gerbasi LS
• Seid VE
• Araujo SEA
• Tustumi F

• KMID: 2547322
• DOI: http://doi.org/10.3393/ac.2022.00605.0086

Abstract

Purpose
This study aimed to review the outcomes of redo procedures for failed colorectal or coloanal anastomoses.
Methods
A systematic review was performed using the PubMed, Embase, Cochrane, and LILACS databases. The inclusion criteria were adult patients undergoing colectomy with primary colorectal or coloanal anastomosis and studies that assessed the postoperative results. The protocol is registered in PROSPERO (No. CRD42021267715).
Results
Eleven articles met the eligibility criteria and were selected. The studied population size ranged from 7 to 78 patients. The overall mortality rate was 0% (95% confidence interval [CI], 0%–0.01%). The postoperative complication rate was 40% (95% CI, 40%–50%). The length of hospital stay was 13.68 days (95% CI, 11.3–16.06 days). After redo surgery, 82% of the patients were free of stoma (95% CI, 75%–90%), and 24% of patients (95% CI, 0%–39%) had fecal incontinence. Neoadjuvant chemoradiotherapy (P=0.002) was associated with a lower probability of being free of stoma in meta-regression.
Conclusion
Redo colorectal and coloanal anastomoses are strategies to restore colonic continuity. The decision to perform a redo operation should be based on a proper evaluation of the morbidity and mortality risks, the probability of remaining free of stoma, the quality of life, and a functional assessment.

Keyword

Colorectal neoplasms; Colorectal surgery; Reoperation; Surgical anastomosis