Results of reoperations in colorectal anastomotic strictures

Schlegel RD, R D Schlegel, Dehni N, N Dehni, R Parc, Parc R, Caplin S, S Caplin, E Tiret, Tiret E
Diseases of the colon and rectum · 2001 · vol. 44(10) , pp. 1464–8 · doi:10.1007/BF02234598 · PMID:11598475
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Surgical resection and new anastomosis construction successfully treated severe colorectal anastomotic strictures, including those associated with rectal endometriosis, restoring intestinal continuity without requiring permanent colostomy.

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This study evaluated the surgical outcomes for 27 patients with severe colorectal anastomotic strictures following initial procedures for conditions including rectal cancer, diverticular disease, and rectovaginal fistulas. The researchers found that resection of the stricture combined with a new anastomosis or Soave’s procedure successfully restored intestinal continuity without recurrence over a mean follow-up of nearly three years. The authors note that while endoscopic dilation is often first-line, surgical intervention remains a viable option with low rates of permanent colostomy requirements. Relevance to endometriosis: Rectal endometriosis was listed as one of the underlying etiologies for the strictures requiring surgery in this cohort.

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Abstract

PURPOSE: The incidence of colorectal anastomotic strictures varies from 3 to 30 percent. Most of these anastomotic strictures are simple narrowings shorter than 1 cm that can be successfully treated by dilation or endoscopic alternatives. However, up to 28 percent of patients will require surgical correction. This can be technically difficult, with the possibility of a permanent colostomy. This study reports the outcomes after operative treatment of severe strictures of colorectal anastomoses. METHODS: From August 1992 to October 1996, 27 patients were referred for surgical treatment of severe rectal anastomotic strictures. The reasons for the initial surgery were as follows: rectal cancer (13), diverticular disease (7), Hirschsprung's disease (2), rectal endometriosis (2), uterine carcinoma with rectal invasion (1), ruptured abdominal aortic aneurysm with rectosigmoid necrosis (1), and rectovaginal fistula (1). There were 15 (56 percent) stapled anastomoses, and 21 (78 percent) patients had developed a postoperative leak. RESULTS: The median time between initial surgery and diagnosis of the stenosis was 7.2 (range, 1-24) months and between the last operation and referral was 15.1 (range, 1-44) months. Stenosis was located at a mean distance of 9.5 (range, 4-15) cm from the anal verge. Eleven patients (41 percent) had been unsuccessfully dilated before referral. Surgical correction of the stenosis required 7 colorectal anastomoses for upper rectal anastomotic strictures and 20 coloanal anastomoses for middle and lower rectal strictures (19 Soave's procedures and 1 colon J-pouch-anal anastomosis). Intestinal continuity was restored in all cases. After a mean follow-up of 28.7 +/- 14 months, no recurrences were detected and functional results were satisfactory. CONCLUSIONS: Resection of the stenosis and construction of a new colorectal anastomosis can be performed successfully for upper rectal anastomotic stricture. For a stenosis located in the middle and lower rectum, Soave's procedure offers a good alternative, with satisfactory long-term functional results. Whichever technique is used, a permanent colostomy should rarely be required.
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Results

of reoperations in colorectal anastomotic strictures - Rodolfo D. Schlegel - Nidal Dehni - Rolland Parc - Scott Caplin - Emmanuel Tiret PURPOSE: The incidence of colorectal anastomotic strictures varies from 3 to 30 percent. Most of these anastomotic strictures are simple narrowings shorter than 1 cm that can be successfully treated by dilation or endoscopic alternatives. However, up to 28 percent of patients will require surgical correction. This can be technically difficult, with the possibility of a permanent colostomy. This study reports the outcomes after operative treatment of severe strictures of colorectal anastomoses.

Methods

From August 1992 to October 1996, 27 patients were referred for surgical treatment of severe rectal anastomotic strictures. The reasons for the initial surgery were as follows: rectal cancer (13), diverticular disease (7), Hirschsprung's disease (2), rectal endometriosis (2), uterine carcinoma with rectal invasion (1), ruptured abdominal aortic aneurysm with rectosigmoid necrosis (1), and rectovaginal fistula (1). There were 15 (56 percent) stapled anastomoses, and 21 (78 percent) patients had developed a postoperative leak.

Results

The median time between initial surgery and diagnosis of the stenosis was 7.2 (range, 1-24) months and between the last operation and referral was 15.1 (range, 1-44) months. Stenosis was located at a mean distance of 9.5 (range, 4-15) cm from the anal verge. Eleven patients (41 percent) had been unsuccessfully dilated before referral. Surgical correction of the stenosis required 7 colorectal anastomoses for upper rectal anastomotic strictures and 20 coloanal anastomoses for middle and lower rectal strictures (19 Soave's procedures and 1 colon J-pouch-anal anastomosis). Intestinal continuity was restored in all cases. After a mean follow-up of 28.7±14 months, no recurrences were detected and functional results were satisfactory.

Conclusions

Resection of the stenosis and construction of a new colorectal anastomosis can be performed successfully for upper rectal anastomotic stricture. For a stenosis located in the middle and lower rectum, Soave's procedure offers a good alternative, with satisfactory long-term functional results. Whichever technique is used, a permanent colostomy should rarely be required.

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Condition tags

endometriosis

MeSH descriptors

Anastomosis, Surgical Anastomosis, Surgical Intestinal Diseases Postoperative Complications Adult Adult Aged Aged Constriction, Pathologic Constriction, Pathologic Female Female Humans Humans Intestinal Diseases Intestinal Diseases Male Male Middle Aged Middle Aged

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