Selective treatment of XXXX with single-stage coloanal or ultralow colorectal anastomosis does not adversely affect morbidity and mortality.

@entity5 @entity1 @entity834 @entity260
BACKGROUND AND AIMS: The surgical treatment of low @entity5 commonly includes low pelvic anastomoses with coloanal or ultralow colorectal anastomoses. @entity834 rates in low pelvic anastomoses range from 4 to 26%. Many surgeons opt to routinely create a diverting ostomy to reduce the extent of morbidity should an @entity834 occur. The intent of our study was to determine if our policy of selected diversion is safe. MATERIALS AND METHODS: A retrospective chart review of 66 @entity5 @entity1 who underwent proctectomy and low pelvic anastomoses -- less than 6 cm from anal verge, with or without a diverting ostomy -- was undertaken. Temporary diverting stomas were utilized at the discretion of the attending surgeon primarily based on subjective criteria. The main outcome was @entity260 . RESULTS/FINDINGS: Forty-nine @entity1 (78% preoperatively irradiated) were treated with a one-stage operation, whereas 17 (53% preoperatively irradiated) underwent reconstruction with proximal diversion. The mean anastomotic height for @entity1 with a single stage procedure was 3.8 cm above the anal verge versus 2.6 for @entity1 with a two-stage procedure (p = 0.076). Complication rates were lower in @entity1 who did not undergo diversion (29% vs 47%, p = 16). With regard to anastomotic-associated complications for single stage versus two stage, complication rates were 8% versus 18%, respectively (p = 0.27). INTERPRETATION/CONCLUSION: Low pelvic anastomoses in @entity5 @entity1 can be safely performed as a single-stage procedure, reserving the use of diversion for select cases.
