Philippine Journal of Surgical Specialties Vol. 76, No. 1, January-June 2021, pp 1-7

Clinical Profile and Outcomes of Patients Undergoing a Turnbull-Cutait Transanal Pullthrough Procedure with Delayed Coloanal Anastomosis (DCAA) at the Philippine General Hospital

Author(s): Marc Paul J. Lopez, MD, FPCS, FPSCRS; Mayou Martin T. Tampo MD; Manuel Francisco T. Roxas, MD, FPCS, FPSCRS and Hermogenes J. Monroy III, MD, FPCS, FPSCRS

Rationale/Objectives: The Turnbull-Cutait transanal pull through procedure with delayed coloanal anastomosis has been widely used before the advent of intestinal stapling devices. It is a viable option for rectal reconstruction for benign and malignant conditions and is able to maintain intestinal continuity without the use of a temporary diversion. It has also been used in salvage operations for pelvic sepsis, failed anastomosis, and tumor recurrence that will otherwise require a permanent ileostomy. This study will describe the technique, as well as the outcomes of patients who underwent the procedure.

Methods: This is a retrospective descriptive study conducted to report the outcomes of patients who underwent the Turnbull-Cutait transanal pull-through with delayed coloanal anastomosis at the Philippine General Hospital from January 2008 to December 2013. Eleven patients were identified using an institutional retrospective database. Clinical data and outcomes were collected using a standard form.

Results: Ten of the 11 patients had an unremarkable postoperative course. One patient had an anastomotic dehiscence. The mean operative time was 229.9 minutes for the 1st stage and 28.2 minutes for the second stage, with a mean blood loss of 463.6 cc for both stages. The mean interval between the two stages was 7.9 days, with an average postoperative length of stay of 8.27 days. The average follow-up was 4.5 years. Functional outcomes were acceptable (average Wexner score 5.63), except for one patient who had an anastomotic dehiscence. No perioperative mortality was noted.

Conclusion: Turnbull-Cutait trans-anal pullthrough procedure with delayed coloanal anastomosis appears to be a safe procedure. The study suggests that it is an alternative strategy in rectal cancer in providing a sphincter-saving surgery, with the establishment of gastrointestinal continuity, and without the need for a proximal diversion. Stoma-less surgery has a notable health economic impact especially in developing countries because it eliminates the costs associated with the use of stoma appliances.

Key words: delayed coloanal anastomosis, rectal cancer, rectal reconstruction, transanal pullthrough, Turnbull-Cutait