The following is a summary of “Is Delaying a Coloanal Anastomosis the Ideal Solution for Rectal Surgery?,” published in the November 2023 issue of Surgery by Collard, et al.
For a study, researchers sought to look at the specific outcomes of delayed coloanal anastomosis (DCAA) based on its two main uses. In the past, DCAA has been suggested either right after a low anterior amputation (primary DCAA) or as a last resort after a main pelvic surgery failed (salvage DCAA).
All patients who had DCAA surgery at 30 hospitals connected to GRECCAR between 2010 and 2021 were included in the study after the fact.
About 564 patients (63% of whom were men; median age: 62 years; interquartile range: 53–69 years) had a DCAA. Around 66% had a main DCAA, and 34% had a salvaging DCAA. Overall, 57% of people got sick, 30% got seriously sick, and 1.1% died. No significant changes existed between the main DCAA and the rescue DCAA (P = 0.933, P = 0.238, and P = 0.410, respectively). Leaks at the anastomosis happened more often after salvaging DCAA (23% vs. 15% after main DCAA, P = 0.016).
55 cases (10%) got atrophy of the colon inside the abdomen. The odds ratio (OR) for intra-abdominal colon necrosis was 2.67 (95% CI: 1.22–6.49; P= 0.020), having a body mass index (BMI) of more than 25 (OR = 2.78 (95% CI: 1.37–6.00; P = 0.006), and having peripheral artery disease (OR = 4.68 (95% CI: 1.12–19.1; P = 0.030). This problem happened just as often with the main DCAA (11%) as it did with the rescue DCAA (8%) (P = 0.289).
Three years after DCAA, 74% of the group (primary DCAA: 77% vs. rescue DCAA: 68%, P = 0.031) still had intact bowels. 75% (301/403) of patients with a DCAA mannered without diverting stoma have never needed a stoma at the most recent follow-up. In the end, DCAA can permanently avoid a stoma in 75% of patients treated without one at the start, and it can also save gut continuity in 68% of patients whose original pelvic surgery failed.
