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

Abstract

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.