Suture clutter can be prevented by a simple method in delayed anastomosis during the Turnbull-Cutait operation

Abstract

The Turnbull-Cutait abdominoperineal pull-through procedure with delayed coloanal anastomosis is used as a salvage procedure in patients with complex anorectal problems that might otherwise require permanent stoma. This procedure is a vialable option in patients with a reoperated, irradiated pelvis with chronic inflammation or infection due to anastomotic leakage, rectovaginal or rectourethral fistula, technical difficulties related to complicated rectal cancer, or other septic conditions. A simple method to prevent suture clutter in a 57-yearold woman, who underwent an abdominoperineal pullthrough procedure with delayed coloanal anastomosis, is presented. She had had anastomotic leakage and chronic pelvic sepsis following low anterior resection with protective ileostomy after neo-adjuvant radiochemotherapy for rectal carcinoma 14 months prior to surgery. Suture clutter can easily lead to prolongation of the operation and to confusion in the delayed Turnbull-Cutait anastomosis. We describe a novel method to prevent suture clutter (Figs. 1–9). The patient had no postoperative complications and was discharged on postoperative day 12. Bladder and sexual functions were normal and the Wexner continence score was 4.0 six months after discharge.