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Year : 2020  |  Volume : 39  |  Issue : 2  |  Page : 409-414

Modification of Turnbull–Cutait transanal colon pull-through as a salvage procedure in cases of failed low colorectal anastomosis

Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence Address:
MD, FRCS (Ed) Ahmed A Abou-Zeid
Professor of General Surgery, Faculty of Medicine, Ain Shams University, 11 El-Ensha Street, Nasr City, Cairo 11371
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejs.ejs_226_19

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Introduction In 1961, Turnbull and Cutait described the colon pull-through with delayed anastomosis for patients with rectal cancers below peritoneal reflection, Hirschsprung disease, and Chagas disease. With the technological upgrading, the surgical staplers offered an easy and safe primary anastomosis in the bottom of the pelvis and replaced the pull-through. Despite this, the pull-through still has a role nowadays in patients with complex anorectal diseases in whom achieving primary anastomosis is difficult even with the use of surgical staplers. Aim The authors are reporting the experience in Turnbull-Cutait pull-through operation, its indications, the technical modification, and the results. Patients and methods A total of 28 patients had two-stage transanal pull through procedure after completing the original resection for different anorectal problems. In the first stage, the left colon was completely mobilized, pulled through, and fixed to the anal canal, and the perianal skin was done, and covering ileostomy was raised. In the second stage, the pull-through was excised few cm below the anal verge, and the ileostomy was closed. Patients were followed up for 6 months to document the continence status and the development of any complications. Results Autoamputation of the colon stump occurred in 10 patients. Retraction of the pulled colon occurred in five patients causing severe pelvic sepsis in three of them. The three patients were treated by dismantling the anastomosis terminal colostomy. Other minor complications included anal pain and discharge. The patients showed wide range of continence state with clear improvement after 6 months. Conclusion Salvage Turnbull–Cutait pull-through is an easy procedure that can be used in patients with complex anastomotic complications and difficult pelvic anatomy. Retraction and gangrene of the colon stump are serious complications that need to be studied to improve the outcome of this procedure. Continence is definitely reduced, but it is accepted by most patients.

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