Turnbull-Cutait Pull-Through –An Old Procedure With a New Indication?

In the study by Biondo et al in this issue of JAMA Surgery, although 30-day postoperative morbidity was similar between the Turnbull-Cutait pull-through procedure with 2-stage hand-sewn coloanal anastomosis (TCA) and a standard hand-sewn coloanal anastomosis and diverting loop ileostomy (CAA/DLI), the anastomotic leak rate was 24% vs 13% for the CAA/DLI and TCA groups, respectively, suggesting a possible trend toward superiority of TCA over CAA/DLI in terms of anastomotic leakage. This is consistent with systematic reviews. Of note, the anastomotic leak rate may be further lowered following a TCA by delaying the hand-sewn anastomosis beyond the 6 to 10 days used in the study by Biondo et al. In fact, in his original description, Daher Cutait did not undertake the hand-sewn anastomosis component until at least several weeks after resection to allow adequate time for the delivered left colon to scar/adhere to the pelvis and anorectal musculature. Similarly, because DLI increases risk for bowel obstruction, the rate of postoperative paralytic ileus of 24% in the CAA/DLI group vs none in the TCA group was not surprising. However, anastomotic stricture, a recognized common problem encountered following a hand-sewn coloanal anastomosis, was not discussed and is a limitation of this study. Furthermore, although short-term results suggest that TCA does not increase postoperative morbidity rates compared with a standard CAA/DLI, we disagree with the authors in calling the TCA a safe p...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research