Abstracts
1999 Digestive Disease Week

# 2095 TURNBULL-CUTAIT PULL THROUGH EXCISION FOR BENIGN DISEASE: INDICATIONS AND OUTCOME
Feza H Remzi, Scott A Strong, Victor W Fazio, Cleveland Clin Fdn, Cleveland, OH

The Turnbull-Cutait abdomino-anal pull through excision was described in 1961 for the treatment of low rectal cancers. As suturing and stapling techniques were refined, this approach was chiefly abandoned. However, we have recently used this technique to salvage patients with benign anorectal problems that might otherwise mandate permanent fecal diversion. The purpose of this study was to review our indications for and outcome following Turnbull-Cutait excisions (TCE). All patients undergoing a TCE between 1996-98 were reviewed for indication, complications, and recurrence. The following data was prospectively collected and compared to a demographically-similar cohort undergoing conventional colo-anal anastomosis (CAA) for rectal cancer: quality of life (SF 36); frequency; urgency; incontinence. During the 3-year period, 12 patients underwent a TCE for complications (i.e., radiation proctitis, abscess, fistula, stricture) affecting a pre-existing low colorectal anastomosis (N=7) or complex anorectal Crohn's disease (N=5). Two patients suffered strictures requiring dilatation and 2 patients persisted with problems that required permanent diversion. Of the 8 patients without a temporary (N=2) or permanent stoma, the quality of life and functional outcome were comparable to that of the CAA patients (N=15) with a median follow-up interval exceeding 12 months. The Turnbull-Cutait abdomino-anal pull through excision safely and satisfactorily salvages patients with colorectal anastomotic complications or complex anorectal Crohn's disease that might otherwise require permanent fecal diversion.

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