Two-step pull-through colo-anal anastomosis aiming to avoid stoma in rectal cancer surgery: A “real life” study in a developing country

Redo surgery after low anterior resection for chronic pelvic sinus and anastomotic disruption. Could pull-through procedure with delayed anastomosis be a feasible alternative? Case reports and narrative review

“…Two-stage pull-through technique could be chosen as first-choice procedure, considering similar rates of short term complications and comparable 1-year oncological and functional outcomes, compared to conventional coloanal anastomosis technique, also avoiding the presence of diverting ileostomy [17] , [20] , [32] , [33] . Furthermore, no significant difference in terms of early post-operative morbidity (frequency of any morbidity, presence of grade 3b morbidity and Comprehensive Complication Index score), has been reported between Turnbull-Cutait technique and standard one-stage coloanal anastomosis [18] , [19] , [34] .…”

“…Turnbull-Cutait abdominoperineal pull-through procedure [15] , [16] was described as first choice treatment in colorectal surgery, especially in patients with mid-rectal cancer and in children with Hirshsprung's disease, until the advent of the stapling technique, and now remains an obsolete treatment, useful as second choice option in re-operated and irradiated pelvis, in chronic infection and also when a covering stoma is refused or dangerous [17] , [18] , [19] , [20] . This is a two-stage technique, including a first step which contemplates low anterior resection, with extraction from the anus of a variable segment of colon, generally about 8-10 cm, that is left in place without suturing; the second step consists in resection of the exteriorized colon and hand-sewn coloanal anastomosis, which are performed after 8–10 days [21] .…”

Evaluation of the implementation of a quality improvement program through morbidity and mortality reviews in a developing country

“… Protocol elaborated and implemented Evaluation study of delayed colo-anal anastomoses. A study was conducted to evaluate this technique [ 39 ] Establish criteria for transferring patients from the ICU to the ward. Protocols to optimize patients' transfer from the ICU to the surgical ward.…”

Audit of laparoscopic surgery for colon cancer in Morocco: A report of the results of a prospective multicentre cohort study

“…In Morocco, training in universities is focused on basic laparoscopic skills, and there is no specific training in advanced laparoscopic procedures [ 25 ]. Surgeons performing advanced mini-invasive techniques got their training in Europe, mostly at their own expenses [ 26 ]. This explains the low number of surgeons performing laparoscopic colectomies and the variability of using laparoscopy between centres.…”