Modified Ileocecal Interposition – The Final Sphincter-Saving Solution after Failed Salvage Surgery for Anastomotic Complications of Low Anterior Resection

Abstract

Introduction: Reversal of low Hartmann’s procedures can be a challenging operation. We report on the successful treatment of patients who have already had prior salvage surgery for complications of a low colorectal anastomosis presenting with active fistulas from the rectal remnant. Methods: An ileocolic segment was mobilized with the neurovascular pedicle of the ileocolic artery and turned counterclockwise into the pelvis. The fistulas were cured and a hand-sutured coloanal anastomosis was performed at the level of the dentate line. Almost the entire length of the remnant colon was preserved. Results: There was no morbidity. The functional outcome was good or reasonable and the subjective satisfaction with the outcome was very high. Conclusion: We conclude that an ileocolic segment is an excellent substitute for reversal of low Hartmann’s procedures even in patients in whom prior salvage surgery has failed. As the functional outcome is slightly inferior to other alternatives for rectal replacement, its use should be restricted to patients with complex local situations or in whom alternative reconstructions would result in significant loss of bowel length.

Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

“…[18][19][20] aside from some publications with anecdotal cases of redo surgery, 13,21,22 our literature review found only 2 surgical teams to date that have reported their experience regarding reoperations for failed CRa or Caa, with a total of 60 patients. 7,12 moreover, one of these reports 7 was limited to patients undergoing anastomotic stricture repair.…”