Delayed anastomosis after rectal surgery was first described by Turnbull and Cutait for Hirschprung's disease, Chagas disease, and rectal cancer. The main objective of this technique is to reduce the risk of anastomotic fistula (AL), thanks to the adhesions that are created between the lowered colon and the anal canal between the first and second operative stages. This technique has seen a revival of interest in recent years, visible in the high number of publications in the last decade. Actual indications for delayed colo-anal anastomosis (DCA) are low rectal cancer and challenging situations in rectal surgery, mainly failed colorectal or coloanal anastomosis. The rate of pelvic septic complications (anastomotic fistula and pelvic abscess) varies between 0 and 35.3%, with most studies reporting low rates. The rate of salvage ostomy creation in the postoperative period varied from 0 to 18.7%. Mortality was NUL in the majority of studies. The rate of poor functional results varied from 0 to 38.5% and functional outcomes appear to improve over time. Few studies compared DCA to one-stage colo-anal anastomosis, with contradictory resulats. These results should be taken with caution because of the low level of available evidence. The ongoing randomized trials, comparing DCA with one-stage colo-anal anastomosis, will define the place of DCA in rectal surgery.
A. Majbar, A. Benkabbou, L. Amrani
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