Salvage abdominal surgery in patients with a retained rectal stump after restorative proctocolectomy and stapled anastomosis

Background: The introduction of surgical stapling instruments has widened the use of restorative proctocolectomy. Too high a distal transection of the rectum can, however, produce a retained rectal stump, which may cause symptoms. A study of the operative and functional data in a consecutive series of patients undergoing salvage surgery for retained rectal stump was undertaken. Methods: Twenty‐five patients referred between January 1990 and September 2000 for pouch dysfunction were identified as having a retained rectal stump. Twenty‐two underwent abdominoanal revision. The hospital notes were reviewed and function was assessed during outpatient visits, by postal questionnaire and by telephone interview. Results: Median operating time was 225 (range 170–340) min and median hospital stay was 15 (range 8–48) days. There was no operative death. Five pouches were excised. Seventeen patients were available for functional assessment. Median follow‐up was 22·5 (range 4–114) months. Median 24‐h frequency before and after operation was 12 (range 4–20) and 6 (range 3–12) respectively, and median night‐time frequency was 4 (range 0–8) and 0·5 (range 0–4) respectively. Fifteen patients reported marked subjective improvement in pouch function and quality of life. Conclusion: Major revisional surgery for symptomatic retained rectal stump after restorative proctocolectomy with stapled anastomosis was successful in 15 of 22 patients. These results are worse than the outcome following first‐time restorative proctocolectomy with anastomosis constructed at the anal level. Pouch–rectal anastomosis should be avoided. © 2001 British Journal of Surgery Society Ltd