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. 2021 Apr;73(2):495-502.
doi: 10.1007/s13304-021-01022-6. Epub 2021 Mar 16.

Short stump and high anastomosis pull-through (SHiP) procedure for delayed coloanal anastomosis with no protective stoma for low rectal cancer

Francesco Bianco  1 , Paola Incollingo  2 , Armando Falato  3 , Silvia De Franciscis  4 , Andrea Belli  4 , Fabio Carbone  5 , Gaetano Gallo  6 , Mario Fusco  7 , Giovanni Maria Romano  8
Affiliations
Free PMC article

Short stump and high anastomosis pull-through (SHiP) procedure for delayed coloanal anastomosis with no protective stoma for low rectal cancer

Francesco Bianco et al. Updates Surg. 2021 Apr.
Free PMC article

Abstract

Despite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed 'Short stump and High anastomosis Pull-through' (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.

Keywords: Coloanal anastomosis; Pull- through; Rectal cancer; Stoma; Turnbull–Cutait.

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Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Second stage: resection of the colic stump and fashioning of the high coloanal anastomosis; a stump at the end of the first stage; b identification of the referral stitches, adhesiolysis, section of the stump and completion of the High coloanal anastomosis; c high coloanal anastomosis at the end of the second stage of the procedure
Fig. 2
Fig. 2
Wexner score trend over time
Fig. 3
Fig. 3
Low anterior resection syndrome score trend over time
Fig. 4
Fig. 4
Schematic representation of the differences between the old and the new pull-through technique
See this image and copyright information in PMC

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