Surgical Resection of Anastomotic Stenosis after Rectal Cancer Surgery Using a Circular Stapler and Colostomy with Double Orifice

Abstract

The double stapling technique has greatly facilitated intestinal reconstruction, particularly for anastomosis after anterior resection. However, anastomotic stenosis may occur, which sometimes requires surgical treatment. Redo surgery with reresection and reanastomosis presents a high risk of complications. Treatment methods need to be selected depending on the degree and location of stenosis. In an effort to propose a new resolution, reporting new cases and sharing valid experiences are necessary. An 82-year-old man diagnosed with rectal cancer had undergone laparoscopic anterior resection. Endoscopic balloon dilation performed for anastomotic stenosis had failed. Therefore, colostomy with double orifice was constructed on the oral side at 10 cm from the stenosis. Approaching from the anal and stoma side, the anastomotic stenosis was resected using a circular stapler. The colostomy was closed 1 month after surgery. Stenosis resection using a circular stapler requires the following steps: (1) passing the center shaft through the stenosis, (2) inserting the anvil head into the oral side of the stenosis, and (3) attaching the anvil head to the center shaft. This method can resect the stenosis using a circular stapler without being affected by postoperative adhesion in the pelvis. Compared to endoscopic balloon dilation, resection of the stricture by the circular stapler is thought to be reliable. This technique is particularly effective for localized stenosis, including anastomotic stenosis. It is considered that this method is minimally invasive and is low risk for complications. This method can contribute to the useful surgical option for refractory anastomotic stenosis after anterior resection.

Clinical and oncological outcomes of the low ligation of the inferior mesenteric artery with robotic surgery in patients with rectal cancer following neoadjuvant chemoradiotherapy

“…In addition, it is also very difficult to manage these anastomosis strictures. Although some authors suggest the resection of this area with circular stapler for the treatment of anastomosis strictures [55], this may not always be possible, since stricture often includes a long colon segment, as in our 3 patients in high ligation group, and sometimes surgery might have to be terminated with an end colostomy, especially in anastomoses located below. Also it can be thought that diversion colitis might be contributed to the high anastomosis stricture rate (28.2%) in the high ligation group in our study.…”

Anatomical Anal Stenosis after PPH: Insights from a Retrospective Study and Rat Model

“…Collagen I, a key component of the extracellular matrix, plays multifaceted functional roles in fibrotic processes, contributing to tissue scarring [ 46 ], organ fibrosis [ 47 , 48 ], and matrix remodeling [ 49 ]. Studies have indicated that fibrotic processes involving collagen deposition can contribute to the development of anal stenosis [ 50 ]. Additionally, the mechanical force can shift fibroblasts towards pro-fibrotic phenotypes, leading to myofibroblast differentiation and excessive collagen production driven by ERK-YAP activation [ 51 ].…”

Transanal Minimally Invasive Surgery for Rectal Anastomotic Stenosis After Colorectal Cancer Surgery

“…Previous studies reported that after dilation procedures, the anastomotic stenosis recurrence risk ranged from 5% to 20%. 13,24,25 Transanal digital dilation or Hegar dilation may be a useful complement to postoperative treatment. Regular colonoscopy is also necessary to evaluate anastomotic stoma and enable early intervention.…”