Abdominoperineal pull-through with delayed coloanal anastomosis for pelvic anastomotic failure-a systematic review

Despite the potential benefits of abdominoperineal pull-through with delayed coloanal anastomosis (DCAA), it is still infrequently performed as a salvage procedure for pelvic anastomotic failure. We aimed to perform a systematic review on the subject to guide practice.

PubMed, Embase and Cochrane were used to identify studies evaluating DCAA for salvage after pelvic surgery from inception to August 2024. Risk of bias assessment was performed using the Newcastle-Ottawa scale. The primary outcome was overall stoma-free survival. Secondary outcomes included hospital length of stay, high-grade postoperative complication rates, 30-day postoperative mortality rates, incidence of redo surgical intervention after DCAA, and postoperative anorectal function.

Five retrospective cohort studies evaluating a total of 97 patients who underwent salvage abdominoperineal pull-through and DCAA were included in this review. All patients had previous pelvic surgery, predominantly proctectomy (n = 84, 86.6%). The most common indication for redo surgery was chronic fistula (n = 62, 63.9%) followed by anastomotic leak or chronic pelvic sepsis (n = 34, 35.1%). The pooled overall stoma-free survival rate across all five studies was 81.4% over a mean 24-month postoperative follow-up duration. The overall incidence of high-grade complications after DCAA was 39.1% (n = 38). Pooled mean length of stay was 17 days. There were no cases of early postoperative death. Pooled rate of repeat surgery across four studies was 11.6% (n = 8). Pooled mean functional scores across three studies indicated minor low anterior resection syndrome at 26 months.

Abdominoperineal pull-through with delayed coloanal anastomosis is a viable option for salvage surgery following pelvic anastomotic complications, with low rates of permanent stoma and acceptable long-term anorectal function.