Department of Colorectal Surgery, Beaujon Hospital (APHP), University Paris VII, Paris, France.
Surgery. 2011 Jan;149(1):65-71. doi: 10.1016/j.surg.2010.03.017. Epub 2010 May 7.
Redo surgery (RS) in patients with failed anastomosis is a rare procedure, and data about this surgery are lacking. The aim of this study was to examine the operative results and long-term outcomes of RS.
All patients who underwent RS between 1999 and 2008 were included. Data were analyzed from a prospective colorectal database. Failure of the procedure was defined as the inability to perform the RS or the inability to close the defunctioning stoma.
Thirty-three patients (22 men) underwent the first surgery at a mean age of 53.4 years. Twenty-four had a colorectal anastomosis (CRA) and nine a coloanal anastomosis (CAA). The reasons for performing RS were stricture (n = 17), prior Hartmann procedure for complication on initial anastomosis (n = 6), chronic fistula (n = 5) or miscellaneous (n = 5). RS was impossible for 2 patients due to extensive adhesions. The mean operating time was 279 min (133-480) and the overall postoperative morbidity rate was 55%. The rate of anastomotic leakage and/or isolated pelvic abscess was 27%. After a mean delay of 3.9 months (0.3-16), 26 patients (79%) had a stoma closure. The mean number of stools per day was 3.2. The failure rates after new handsewn CAA and new stapled CRA were 33% (4/12) and 5% (1/19), respectively (P = .0385). The type of the former anastomosis influenced the success rate of restoring the intestinal continuity: failure rate after prior CAA was 56% and 8% after prior CRA (P = .0031).
Redo surgery for failure of previous CRA or CAA is feasible but requires a demanding surgical procedure with high short-term morbidity.
吻合口失败后的翻修手术（RS）较为少见，目前相关数据较少。本研究旨在探讨 RS 的手术结果和长期预后。
纳入 1999 年至 2008 年间行 RS 的所有患者。数据来自前瞻性结直肠数据库。手术失败定义为无法进行 RS 或无法关闭预防性造口。
33 例患者（22 例男性）首次手术时的平均年龄为 53.4 岁。24 例行结直肠吻合术（CRA），9 例行结肠肛管吻合术（CAA）。行 RS 的原因包括狭窄（n=17）、初次吻合并发症行 Hartmann 手术后（n=6）、慢性瘘（n=5）或其他原因（n=5）。2 例患者因广泛粘连而无法进行 RS。手术时间平均为 279 分钟（133-480 分钟），总体术后发病率为 55%。吻合口漏和/或孤立性盆腔脓肿发生率为 27%。在平均 3.9 个月（0.3-16 个月）的延迟后，26 例（79%）患者行造口关闭。平均每天排便次数为 3.2 次。新手工 CAA 和新吻合器 CRA 的失败率分别为 33%（4/12）和 5%（1/19）（P=0.0385）。前次吻合术的类型影响重建肠道连续性的成功率：前次 CAA 失败率为 56%，CRA 为 8%（P=0.0031）。
对于先前 CRA 或 CAA 失败的 RS 是可行的，但需要进行高难度的手术，短期发病率较高。
