The retro-ileal pull-through technique for colorectal and coloanal anastomosis.

Background: Performing a tension-free anastomosis following extensive left-sided colorectal resection can be challenging due to limited length. The retro-ileal pull-through approach, where the colon is carefully delivered to the pelvis through a mesenteric window made under the ileocolic vessels, is a technique to perform such an anastomosis.

Methods: This series is a retrospective review of patients who underwent a colorectal or coloanal anastomosis using the retro-ileal pull-through approach. Patient demographics, operative reports, and short-term outcomes were reviewed.

Results: Seven patients had a retro-ileal pull-through technique with colorectal or coloanal anastomosis. The cohort included 3 patients who had a Hartman's reversal, 3 who had a redo colorectal anastomosis and one in whom this technique was used in an acute setting for sigmoid colectomy for acute perforated diverticulitis with primary anastomosis. Successful implementation of the technique was achieved in all patients with good short-term outcomes.

Conclusions: In our cohort of patients, a retro-ileal pull-through technique was shown to be a successful approach to achieve a tension-free colorectal or coloanal anastomosis in various scenarios. This technique may prevent performing an ileorectal anastomosis or a permanent colostomy. We believe that this approach should be popularized among colorectal surgeons dealing with complicated colorectal operations.