Outcome analysis of external coloanal anastomosis

To evaluate the safety and efficacy of treating low-lying rectal lesions with resection and primary repair using a pull-through technique with rectal stump eversion and external coloanal anastomosis with immediate reintroduction into the pelvis.

All coloanal anastomoses with the above technique on the Gastrointestinal Surgery Service at the University of Pittsburgh from March 1990 to September 1995 were evaluated.

Fifty-two patients underwent coloanal anastomoses with the above technique, and follow-up was available for 96% (50 of 52) of patients. Rectal lesions in the 50 patients included cancer (n = 34), rectal adenomas (n = 13), and other lesions (n = 3). Mean follow-up period was 29.6 +/- 21.8 months (28.5 months for patients with carcinoma). Fecal continence was normal or good in 88% (44 of 50) of patients. Moderate or complete incontinence was present in 12% (6 of 50) of patients. The local recurrence rate of rectal cancer was 0%. Morbidity occurred in 22% (11 of 50) of patients. Survival was 90% (45 of 50 patients).

Coloanal anastomosis with this technique provides effective treatment for low-lying malignant or benign rectal lesions and has an acceptable complication rate.