Soave's procedure: the final sphincter-saving solution for iatrogenic rectal lesions

• Published in: British journal of surgery Vol. 85; no. 7; pp. 962 - 964
• Main Authors: Faucheron, J. L., Rosso, R., Tiret, E., Keli, E., Nugent, K. P., Frileux, P., Parc, R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-07-1998; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical - adverse effects; Biological and medical sciences; Digestive System Surgical Procedures - methods; Digestive System Surgical Procedures - mortality; Female; Follow-Up Studies; Humans; Long-Term Care; Male; Medical sciences; Middle Aged; Radiation Injuries - etiology; Radiation Injuries - surgery; Reconstructive Surgical Procedures - adverse effects; Rectum - injuries; Rectum - surgery; Retrospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Soave operation; Iatrogenic; Rectal disease; Treatment efficiency; Morbidity; Treatment; Surgery; Digestive diseases; Intestinal disease; Evolution; Anal incontinence; Technique
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.1365-2168.1998.00725.x

Background
Restoring intestinal continuity in the presence of radiation‐induced rectal lesions and following low colorectal anastomotic complications or low Hartmann's procedure may be fraught with difficulties. Soave's procedure avoids potentially hazardous perirectal dissection. This study examined the morbidity and mortality as well as functional results.
Methods
Between January 1978 and July 1994 30 consecutive patients underwent Soave's operation as a final attempt to restore coloanal continuity. The pathology was radiation‐induced lesions in 15 patients, low colorectal anastomotic complications in nine and low Hartmann's reconstruction in six.
Results
Mean length of follow‐up was 4·2 (range 1–16) years. There was no operative mortality. Early complications included one patient with postoperative haemorrhage, one with small bowel obstruction and four with pelvic or perineal sepsis. Late complications included four incisional hernias, three anastomotic strictures which were treated by dilatation, and one recurrent ischaemic colitis. Continence was normal in 19 of 23 evaluable patients.
Conclusion
Soave's procedure obviates the need for extensive pelvic dissection, providing good technical and functional results in both the long and short term. © 1998 British Journal of Surgery Society Ltd