The failed colorectal anastomosis: Turnbull–Cutait as a salvage option

Abstract

The incidence of colorectal anastomotic leaks is approximately 5–19 % of cases, posing a threat to intestinal continuity, particularly if the leak arises after a low or ultra-low colorectal anastomosis. A Turnbull–Cutait procedure can be a salvage option for such patients and they may be eligible if they are adequate redo pelvic surgery candidates, who are motivated to regain intestinal continuity, and who have good continence and anal function at baseline. The first stage of the procedure is colonic mobilization and pull-through after perineal division at the top of the anorectal complex and mucosectomy. A diverting loop ileostomy is utilized. The second stage is amputation of the excess colon and creation of a hand-sewn colo-anal anastomosis, typically performed 7 days later. Outcomes after a Turnbull–Cutait procedure are reasonable based on a series from specialized centers with 80–90 % of patients having a complete Turnbull–Cutait and reversal of the diverting ileostomy. Low anterior resection syndrome is common. In the long-term, studies show that just over half of patients will remain stoma free at 5 years; fecal incontinence is the main reason for failure and return to a stoma. The prospect of a Turnbull–Cutait can be kept in mind when addressing an anastomotic leak in appropriate patients; this may allow for surgical decision-making that makes it feasible to utilize a Turnbull–Cutait in the future.