Turnbull procedure-analysis of a cohort in the salvage setting

The Turnbull procedure (coloanal pull-through with delayed coloanal anastomosis, DCAA) serves as a salvage option for complex, therapy-refractory pelvic floor disorders to avoid permanent colostomy. This study evaluated the perioperative outcomes, stoma avoidance, and functional results of 16 patients treated between 2018 and 2024.

A retrospective analysis of 16 consecutive patients with hostile pelvis (e.g., post-surgical fistulas, chronic pelvic sepsis, and Crohn's disease). The key outcomes were time to anastomosis, Clavien-Dindo complications, stoma reversal rate, SF-12 quality of life, LARS, and Wexner continence score. Follow-up = 19-80 months.

Anastomosis occurred after a mean of 11 days (range, 6-19 days). Permanent stoma was avoided in 13/16 (81%) patients. Perioperative morbidity was low, and the SF-12 scores (14/16) ranged from 29 to 86%, correlating with the LARS (p = 0.016). In 12 patients, minor LARS was observed in 3/12, major LARS in 7/12, the Wexner incontinence score showed good continence in 4/12, moderate incontinence in 5/12, and severe incontinence in 3/12. The fistula subgroup showed the best functional results.

The Turnbull/DCAA procedure enables sphincter preservation in complex pelvic disorders, particularly postoperative fistulas. Despite frequent major LARS and incontinence, 81% of the patients avoided permanent stoma. Meticulous selection and informed consent are essential because of the functional limitations.