Management of benign anastomotic strictures following rectal resection: a systematic review

Clifford, Rachael; Fowler, Hayley; Manu, Nicola; Vimalachandran, Dale

doi:10.1111/codi.15865

Cited by 19 publications

(13 citation statements)

References 55 publications

(70 reference statements)

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“…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 ]. This case presented three years after initial resection and anastomosis with acute LBO after two follow-up colonoscopies demonstrating no evidence of early stricture.…”

Section: Discussionmentioning

confidence: 99%

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

Wallace

Gallagher²

2023

Journal of Surgical Case Reports

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Benign anastomotic strictures most commonly occur within 3–12 months after anterior resection (AR) with chronic symptoms amenable to endoscopic treatment. This case describes an acute large bowel obstruction secondary to a severe delayed benign anastomotic stricture in a 74-year-old female who had previously underwent a laparoscopic AR for sigmoid adenocarcinoma 3 years prior. The pathophysiology of benign anastomotic strictures remains poorly understood. This case was likely multifactorial. Potential contributing factors include anastomotic ischaemia and concomitant collagenous colitis, with inflammation leading to fibrosis and stricture development. Surgical techniques to optimize anastomotic vascularity are important to consider, particularly in older patients with multiple co-morbidities.

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Section: Discussionmentioning

confidence: 99%

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

Wallace

Gallagher²

2023

Journal of Surgical Case Reports

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“…While many studies have thoroughly analyzed the risk factors of anastomotic leakage, relatively few studies have focused on risk factors of anastomotic stricture. Rates have been shown to vary from 2%–30% in the literature, but these rates are usually under-reported due to the requirement for long-term follow-up[ 24 ]. In addition, while high-grade strictures are immediately recognized due to patient symptoms, low-grade strictures are not always identified[ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Nomogram to predict permanent stoma in rectal cancer patients after sphincter-saving surgery

Kuo¹,

Wei²,

Chen³

et al. 2022

WJGS

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BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma (PS), which can cause drastic changes in lifestyle and physical perceptions. AIM To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery. METHODS A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve. RESULTS The PS rate after sphincter-saving surgery was 15.1% (59/391) in our study after a median follow-up of 47.3 mo (range 7–114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903 (95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model. CONCLUSION Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.

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“…A dreaded complication of the procedure is anastomotic stenosis, which occurs in approximately 3–30 % of cases [1] . Depending on the degree of stenosis, various therapeutic techniques can be employed, including balloon dilation, endoscopic stenting, stapled stricturoplasty, steroids and electro-incision [2] , [3] . The most challenging cases include complete stenosis of the lumen, which frequently require surgical excision of the stenotic section of bowel with re-anastomosis [4] .…”

Section: Introduction and Importancementioning

confidence: 99%

EUS-guided management of anastomotic stricture: A case report

Beck¹,

Neto²,

Burneikis³

et al. 2023

International Journal of Surgery Case Reports

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Management of benign anastomotic strictures following rectal resection: a systematic review

Cited by 19 publications

References 55 publications

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

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

Nomogram to predict permanent stoma in rectal cancer patients after sphincter-saving surgery

EUS-guided management of anastomotic stricture: A case report

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