Delayed coloanal anastomosis after previous colorectal surgery failure

Colorectal surgery is subject to a rate of major complications, especially after neo-adjuvant radiotherapy. Between October 1994 and August 2011, 46 patients have benefited from a « delayed » coloanal anastomosis (DCAA) to restore coloanal continuity. Pelvic radiotherapy was performed in 17 patients. The pathology was septic anastomotic complications in 33 patients, low Hartmann’s reconstruction in four, rectal perforation in one, colic ischemia in two and selected pelvic local cancer recurrence (ovarian, rectal, appendiceal) in six.Mean follow-up was 65 months (range 6-192). There was no operative mortality. Overall morbidity was 33 %. There were no anastomotic leakage, three local infections, one colic ischemia and one ileovaginal fistula. The functional results were good or acceptable respectively in 73 % and 88 % of evaluable patients at one year and two years. At the end of follow-up, only three patients kept a stoma: two for poor functional outcome and one for ileovaginal fistula.After low colorectal anastomosis failure or low Hartmann’s procedure or in some selected cases of pelvic cancer recurrence, DCAA is a safe procedure, with only 6 % of septic complications. DCAA is an alternative to Soave’s procedure for sphincter preservation.