Restorative resection: coloanal anastomosis for benign and malignant disease

Sixteen patients underwent anterior resection and coloanal anastomosis between October 1984 and September 1987. Indications included adenocarcinoma of the low rectum in 9, villous tumor in 2, carcinoid tumor in 1, radiation proctitis in 1, adult onset Hirschprung's disease in 1, rectourethral fistula in 1, and megarectum in 1. There was no in-hospital mortality and no anastomotic dehiscence. The Kirwan classification was used to evaluate functional results. Ninety-three percent of patients expressed satisfaction with their surgical results. Eighty-seven percent of patients are normally continent. A single patient is grossly incontinent. Eight of nine patients with carcinoma were resected for cure. A single patient has died of an unrelated disorder and the remaining seven are free of disease at an average follow-up of 24 months. The authors conclude that coloanal anastomosis is a safe procedure accompanied by minimal morbidity, or risk of local recurrence. Excellent, or at least acceptable, continence can be anticipated in the majority of carefully selected patients. The coloanal anastomosis should be strongly considered in any patient with a low-lying rectal lesion in whom body habitus precludes the possibility of conventional low anterior resection.