Available online 20 October 2023, 100988

Author links open overlay panel, 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.

Section snippetsHistory of Turnbull-Cutait

In the early 1900s, pull-through techniques were described and typically involved the invagination of the upper rectum through the anus for resection and anastomosis and then return to the pelvis.8 In 1950, Swenson published his pull-through technique for the treatment of Hirschsprung's disease.9 Complications included ischemic necrosis of the colonic conduit, retraction of the conduit, and anastomotic leakage.10 In 1952, Dr. Rupert Turnbull started performing a two-stage pull-through with the

Conclusion

The Turnbull-Cutait is a salvage option for complex low pelvic pathology, particularly distal colorectal anastomotic leak. It is most commonly used in the chronic setting, but highly select otherwise healthy patients may be candidates in the acute setting of anastomotic leak for Turnbull-Cutait reconstruction. When patients require return to the operating room for an ostomy in the setting of an acute symptomatic leak, thinking ahead and planning the stoma with the mindset of future

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