The Turnbull Cutait pull-through procedure (TCO) restores intestinal continuity in the setting of chronic pelvic sepsis, colorectal anastomotic leak, complex pelvic fistulas, and technical challenges related to complicated rectal cancer.
The aim of this study was to evaluate the outcomes of TCO for salvaging complex pelvic conditions and compare it to hand-sewn immediate coloanal anastomosis (CAA).
This is a retrospective single-institution study where we searched a prospectively-maintained database to identify patients who underwent TCO. Patients demographics, operative indications and outcomes were analyzed. TCO success was defined as maintenance of intestinal continuity and being stoma-free. Kaplan-Meier analysis was employed for stoma-free survival analysis.
A total of 81 patients with TC and 129 patients with CAA were included. The TCO success rate was 69% at a median of 1.4 years follow-up with 25 (31%) patients ending up with a permanent stoma compared to 22 (17%) in the CAA group with a median follow-up of 4 years (p=0.03). The Kaplan-Meier cumulative incidence of TCO success at 1, – 3-, and 5- years was 79%, 60%, and 51%, compared to 91%, 81%, and 73% after CAA, respectively.
TCO operation has a high success rate for patients with complex pelvic conditions who may be facing permanent stoma as their only option.

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