Date: 15 Nov 2012
Colorectal anastomotic stricture: Is it associated with inadequate colonic mobilization?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Anastomotic stricture or stenosis is a well-described complication of intestinal anastomosis. The incidence of stricture after colorectal anastomosis ranges from 0 to 30 %. The aim of this study was to identify possible factors related to postoperative colorectal anastomotic stricture and to indicate reoperative surgery outcomes.
After institutional review board approval, medical records were reviewed for patients who underwent surgery for colorectal anastomotic stricture at Cleveland Clinic Florida between January 2001 and December 2010. The main outcome measures were demographics, indications for initial surgery, body mass index, comorbidities, previous treatment, level of anastomosis, history of radiotherapy, and operative data for the reoperative surgery.
Nineteen patients (15 males) were eligible for the study. Nine patients had a diagnosis of cancer, 7 of whom received radiotherapy. The initial surgeries were low anterior resection (n = 9; 47.4 %), high anterior resection (n = 9; 47.4 %), and sigmoidectomy (n = 1; 5.2 %). Six patients (31.6 %) had anastomotic leak after initial surgery. The majority of the patients (n = 17; 89.5 %) had an intact splenic flexure, inferior mesenteric artery, and inferior mesenteric vein. In all patients, full mobilization of the splenic flexure and high ligation of the mesenteric vessels was performed. Seven patients (36 %) developed postoperative complications. Over a mean follow-up of 24.3 months, there was no recurrence of anastomotic stricture.
An intact splenic flexure and mesenteric vessels were the most prevalent in patients who underwent reoperation at our institution. Full mobilization of the splenic flexure, high ligation of the mesenteric vessels, anastomotic stricture resection, and re-anastomosis can be successfully performed with satisfactory outcomes.
Sarker SK, Chaudhry R, Sinha VK (1994) A comparison of stapled vs handsewn anastomosis in anterior resection for carcinoma rectum. Indian J Cancer 31:133–137PubMed
Fasth S, Hedlund H, Svaninger G, Hulten L (1982) Autosuture of low colorectal anastomosis. Acta Chir Scand 148:535–539PubMed
Baran JJ, Goldstein SD, Resnik AM (1992) The double-staple technique in colorectal anastomoses: a critical review. Am Surg 58:270–272PubMed
World Health Organization (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 854:1–452
de Lange EE, Shaffer HA Jr (1991) Rectal strictures: treatment with fluoroscopically guided balloon dilation. Radiology 178:475–479PubMed
Skreden K, Wiig JN, Myrvold HE (1987) Balloon dilation of rectal strictures. Acta Chir Scand 153:615–617PubMed
Dworkin MJ, Allen-Mersh TG (1996) Effect of inferior mesenteric artery ligation on blood flow in the marginal artery-dependent sigmoid colon. J Am Coll Surg 183:357–360PubMed
Chung RS, Hitch DC, Armstrong DN (1988) The role of tissue ischemia in the pathogenesis of anastomotic stricture. Surgery 104:824–829PubMed
- Colorectal anastomotic stricture: Is it associated with inadequate colonic mobilization?
Techniques in Coloproctology
Volume 17, Issue 4 , pp 371-375
- Cover Date
- Print ISSN
- Online ISSN
- Springer Milan
- Additional Links
- Anastomosic stricture
- Colorectal anastomosis
- Splenic flexure mobilization
- High ligation of inferior mesenteric artery
- Industry Sectors