Turnbull procedure – analysis of a cohort in the salvage setting

Purpose: The Turnbull procedure (coloanal pull-through with delayed coloanal anastomosis, DCAA) serves as a salvage option for complex, therapy-refractory pelvic floor disorders to avoid permanent colostomy. This study evaluated the perioperative outcomes, stoma avoidance, and functional results of 16 patients treated between 2018 and 2024. Methods: A retrospective analysis of 16 consecutive patients with hostile pelvis (e.g., post-surgical fistulas, chronic pelvic sepsis, and Crohn´s disease). The key outcomes were time to anastomosis, Clavien-Dindo complications, stoma reversal rate, SF-12 quality of life, LARS, and Wexner continence score. Follow-up: 19–80 months Results: Anastomosis occurred after a mean of 11 days (range, 6–19 days). Permanent stoma was avoided in 13/16 (81%) patients. Perioperative morbidity was low, and the SF-12 scores (14/16) ranged from 29% to 86%, correlating with the LARS (p=0.016). In 12 patients, minor LARS was observed in 3/12, major LARS in 7/12, Wexner good continence in 4/12, moderate in 5/12, and severe in 3/12. The fistula subgroup showed the best functional results. Conclusions: The Turnbull/DCAA procedure enables sphincter preservation in complex pelvic disorders, particularly postoperative fistulas. Despite frequent major LARS and incontinence, 81% of the patients avoided permanent stoma. Meticulous selection and informed consent are essential because of the functional limitations.