Department of Colorectal Surgery, Pôle Des Maladies de L'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
Sorbonne Université, 15-21 rue de l'Ecole de Médecine, 75006, Paris, France.
Int J Colorectal Dis. 2021 Sep;36(9):2057-2060. doi: 10.1007/s00384-021-03982-y. Epub 2021 Jun 24.
Colorectal redo surgery is well known to be a difficult procedure, associated with a high risk of failure. The aim of this study was to look into patients presenting two consecutive failed colorectal (CRA) or coloanal (CAA) anastomosis who underwent a second redo surgery (i.e., third anastomosis).
A retrospective study based on a prospective database of second redo surgeries of CRA or CAA, in an expert center. Sixteen patients between 2005 and 2020 were analyzed.
After a mean follow-up of 28 ± 26 months, success of surgery (defined as no stoma at the end of follow-up) was reported in 10/16 patients (63%). One patient with chronic anastomotic leakage and another with early colonic ischemia had no defunctioning stoma reversal. In the remaining four patients with a failed second redo surgery, a definitive stoma was ultimately created for fistula recurrence (n = 1), poor functional results (n = 2), or local cancer recurrence (n = 1). Two risk factors for failure of this second redo surgery were significantly found in a univariate analysis: (1) nature of the primary anastomosis: 3/13 s redo surgeries failed (23%) if a CRA was first made and 3/3 (100%) if it was a CAA (p = 0.036); (2) age: patients with a failed second redo surgery were older (p = 0.04).
A 63% rate of success of second redo surgery was observed after two failed CRA or CAA. Although a demanding procedure, it can be proposed to carefully selected and motivated patients.
众所周知，结直肠再手术是一种难度较大的手术，失败风险较高。本研究旨在探讨两次连续失败的结直肠（CRA）或结肛（CAA）吻合术后行再次再手术（即第三次吻合术）的患者。
这是一项基于 CRA 或 CAA 再次再手术的前瞻性数据库的回顾性研究，在一个专家中心进行。分析了 2005 年至 2020 年间的 16 例患者。
平均随访 28±26 个月后，16 例患者中有 10 例（63%）手术成功（定义为随访结束时无造口）。1 例慢性吻合口漏和 1 例早期结肠缺血患者未行预防性造口还纳术。在其余 4 例再次再手术失败的患者中，最终因瘘复发（n=1）、功能结果不佳（n=2）或局部癌症复发（n=1）行确定性造口术。单因素分析发现，有两个因素与该再次再手术的失败相关：（1）初次吻合术的性质：如果首次行 CRA 再手术，则 3/13 例（23%）再手术失败，而如果首次行 CAA，则 3/3 例（100%）再手术失败（p=0.036）；（2）年龄：再次再手术失败的患者年龄较大（p=0.04）。
两次 CRA 或 CAA 失败后再次再手术的成功率为 63%。尽管这是一项要求较高的手术，但可以向精心挑选和积极的患者推荐。
