Right and Wrong Approaches To Colorectal Anastomotic Strictures: When? Which Technique?

Abstract

Objective: The aim of this study was to examine and describe the efficiency of endoscopic balloon and bougie dilatation techniques applied to anastomotic strictures developed in patients who underwent a low anterior resection (LAR) and ileostomy.Methods: A total of 167 patients underwent an LAR with an ileostomy due to rectal cancer between July 2014 and December 2017. Nineteen (%11.4) cases with anastomosis stricture were retrospectively evaluated and included in the study. Patients were classified according to the dilation time. Group 1 patients received dilatation within the first 3 months postoperatively, and Group 2 patients received dilatation after 3 months. Demographic data, the dilatation technique, the number of dilatation applications, the level of the stricture, the success rate, and the stoma closure time were evaluated. Results:In Group 1, the mean number of dilatation procedures was 1.8 (range: 1-3), whereas in Group 2, the mean was 3.8 (range: 2-5). The success rate was 100% in Group 1 and 66.6% in Group 2. There was a statistically significant difference between the groups in the requirement for dilatation and the success rate (p=0.022, p=0.028, respectively). Conclusion:It was concluded that dilatation techniques are most successful when applied within 3 months after surgery in cases with stenotic anastomoses. The risk of strictures and the number of repeated dilatations was lower and the success rate was significantly higher in these cases.

A delayed benign anastomotic stricture after anterior resection for sigmoid adenocarcinoma with concomitant collagenous colitis

“…These commonly occur within 3–12 months post-operatively, often presenting either asymptomatically on surveillance or with chronic symptoms of bowel habit changes, intermittent abdominal pain and distension or fractionated evacuation [ 3 , 4 , 6 , 8 ]. The use of endoscopic dilatation, electrocautery or stricturoplasty is emphasized with success rates of 80–100% [ 3 , 9 ]. Surgery is reserved for refractory, long segment strictures or emergency cases [ 4 , 7 , 8 , 10 ].…”