Skip to main content

Advertisement

Log in

Management of Benign Rectal Strictures

A Review of Present Therapeutic Procedures

  • Current Status
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: A significant benign stricture of the rectum is uncommon but can be a recalcitrant condition to treat. Case reports detailing a particular treatment option abound in the surgical literature. An overall précis of the different techniques available is presented, with a comparison of their relative strengths and weaknesses. METHODS: A literature search was undertaken from 1963 to the present day, using MEDLINE. Keywords were benign, strictures, and rectum. RESULTS: Balloon dilation is the most frequent intervention described in the literature. Repeated dilation with time often is required to achieve normal bowel function. Electrocautery resection or incision combined with dilation increases the success rate without increasing the complication rate. Transanal strictureplasty with mechanical staplers is reported as achieving the best success with the smallest complication rate; however, only a minority of strictures are suitable to be managed in this way, and therefore, the numbers treated are small. CONCLUSIONS: All of the techniques reviewed compared favorably with formal stricture resection in terms of success rate and complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. RD Schlegel N Dehni R Parc S Caplin E Tiret (2001) ArticleTitleResults of reoperations in colorectal anastomotic strictures Dis Colon Rectum 44 1464–1468

    Google Scholar 

  2. MA Luchtefeld JW Milsom A Senagore JA Surrell WP Mazier (1989) ArticleTitleColorectal anastomotic stenosis. Results of a survey of the ASCRS membership Dis Colon Rectum 32 733–736

    Google Scholar 

  3. CL Simmang SW Lacey PJ Huber SuffixJr (1998) ArticleTitleRectal sleeve advancement Dis Colon Rectum 41 787–789

    Google Scholar 

  4. AS Puri JC Vij A Chaudhary et al. (1996) ArticleTitleDiagnosis and outcome of isolated rectal tuberculosis Dis Colon Rectum 39 1126–1129

    Google Scholar 

  5. S Alsalameh R al-Ward P Berg T Aigner C Ell (2000) ArticleTitleRectal stricture associated with the long-term use of ibuprofen suppositories Z Rheumatol 59 348–351

    Google Scholar 

  6. S Papagrigoriadis JA Rennie (1998) ArticleTitleLymphogranuloma venereum as a cause of rectal strictures Postgrad Med J 74 168–169

    Google Scholar 

  7. D Hayne CJ Vaizey PB Boulos (2001) ArticleTitleAnorectal injury following pelvic radiotherapy Br J Surg 88 1037–1048

    Google Scholar 

  8. K Rogers LE Hughes (1982) ArticleTitleRectal strictures associated with the intra-uterine contraceptive device Br J Surg 69 151–152

    Google Scholar 

  9. SS Brennan IR Pickford M Evans AV Pollock (1982) ArticleTitleStaples or sutures for colonic anastomoses Br J Surg 69 722–724

    Google Scholar 

  10. AL Polglase ES Hughes FT McDermott E Pihl FR Burke (1981) ArticleTitleA comparison of end-to-end staple and suture colorectal anastomosis in the dog Surg Gynecol Obstet 152 792–796

    Google Scholar 

  11. AJ Dziki MD Duncan JW Harmon et al. (1991) ArticleTitleAdvantages of handsewn over stapled bowel anastomosis Dis Colon Rectum 34 442–448

    Google Scholar 

  12. RP Miles (1972) ArticleTitleThe surgery of some strictures and stenoses. Benign strictures of the rectum Ann R Coll Surg Engl 50 310–311

    Google Scholar 

  13. R Hesterberg WU Schmidt F Muller HD Roher (1993) ArticleTitleTreatment of anovaginal fistulas with an anocutaneous flap in patients with Crohn’s disease Int J Colorectal Dis 8 51–54

    Google Scholar 

  14. TL Hull VW Fazio (1997) ArticleTitleSurgical approaches to low anovaginal fistula in Crohn’s disease Am J Surg 173 95–98

    Google Scholar 

  15. WE Conner AB Jetmore JW Heryer (1995) ArticleTitleCircular stapled rectal stricturoplasty with the Proximate intraluminal stapler Dis Colon Rectum 38 660–663

    Google Scholar 

  16. AH Ross (1980) ArticleTitleRectal stricture resection using the EEA autostapler Br J Surg 67 281–282

    Google Scholar 

  17. A Ovnat J Peiser E Avinoah I Charuzi (1989) ArticleTitleA new approach to rectal anastomotic stricture Dis Colon Rectum 32 351–353

    Google Scholar 

  18. CP Hinton LR Celestin (1986) ArticleTitleA new technique for excision of recurrent anastomotic strictures of the rectum Ann R Coll Surg Engl 68 260–261

    Google Scholar 

  19. S Pagni CM McLaughlin (1995) ArticleTitleSimple technique for the treatment of strictured colorectal anastomosis Dis Colon Rectum 38 433–434

    Google Scholar 

  20. S Shimada M Matsuda K Uno H Matsuzaki S Murakami M Ogawa (1996) ArticleTitleA new device for the treatment of coloproctostomic stricture after double stapling anastomoses Ann Surg 224 603–608

    Google Scholar 

  21. S Benoist Y Panis S Berdah P Hautefeuille P Valleur (1998) ArticleTitleNew treatment for ileal pouch-anal or coloanal anastomotic stenosis Dis Colon Rectum 41 935–937

    Google Scholar 

  22. M Anvari (1998) ArticleTitleEndoscopic transanal rectal stricturoplasty Surg Laparosc Endosc 8 193–196

    Google Scholar 

  23. SB Lausten P Saksoo (1994) ArticleTitleTreatment of a stenotic colorectal anastomosis by transanal use of an endoscopic stapler Br J Surg 81 144–196

    Google Scholar 

  24. F Accordi O Sogno S Carniato et al. (1987) ArticleTitleEndoscopic treatment of stenosis following stapler anastomosis Dis Colon Rectum 30 647–649

    Google Scholar 

  25. MJ Kelly (1989) ArticleTitleUse of the urological resectoscope in benign and malignant rectal lesions J R Soc Med 82 588–590

    Google Scholar 

  26. CD Sutton LJ Marshall SA White N Flint DP Berry MJ Kelly (2002) ArticleTitleTen-year experience of endoscopic transanal resection Ann Surg 235 355–362

    Google Scholar 

  27. TM Hunt MJ Kelly (1994) ArticleTitleEndoscopic transanal resection (ETAR) of colorectal strictures in stapled anastomoses Ann R Coll Surg Engl 76 121–122

    Google Scholar 

  28. YW Chia SS Ngoi KH Tung (1991) ArticleTitleUse of the optical urethrotome knife in the treatment of a benign low rectal anastomotic stricture Dis Colon Rectum 34 717–719

    Google Scholar 

  29. G Winde B Reers T Berns H Bunte (1995) ArticleTitleTransanal endoscopic microsurgical resection of anastomotic stricture following anterior resection of the rectum Aktuelle Chirugie 30 136–139

    Google Scholar 

  30. A Luck P Chapuis G Sinclair J Hood (2001) ArticleTitleEndoscopic laser stricturotomy and balloon dilatation for benign colorectal strictures ANZ J Surg 71 594–597

    Google Scholar 

  31. JR Boyle MM Thompson B Lopez MH Twist MJ Kelly (1997) ArticleTitleTUR syndrome and endoscopic transanal resection Br J Surg 84 831–833

    Google Scholar 

  32. B Debras R Bergamaschi G Becouarn JP Arnaud (1996) ArticleTitleAbsorption of glycine irrigating solution during endoscopic transanal resection of rectal tumours Dis Colon Rectum 39 1245–1248

    Google Scholar 

  33. S Truong S Willis V Schumpelick (1997) ArticleTitleEndoscopic therapy of benign anastomotic strictures of the colorectum by electroincision and balloon dilatation Endoscopy 29 845–849

    Google Scholar 

  34. A Hagiwara T Togawa J Yamasaki M Shirasu C Sakakura H Yamagishi (1999) ArticleTitleEndoscopic incision and balloon dilatation for cicatricial anastomotic strictures Hepatogastroenterology 46 997–999

    Google Scholar 

  35. G Buess R Theiss F Hutterer et al. (1983) ArticleTitleTransanale endoskopische chirugie des rektums Leber Magen Darm 13 73–77

    Google Scholar 

  36. K Azimuddin RD Riether JJ Stasik L Rosen IT Khubchandani JF Reed SuffixIII (2000) ArticleTitleTransanal endoscopic microsurgery for excision of rectal lesions Surg Laparosc Endosc Percutan Tech 10 372–378

    Google Scholar 

  37. K Kato T Saito M Matsuda M Imai S Kasai M Mito (1997) ArticleTitleSuccessful treatment of a rectal anastomotic stenosis by transanal endoscopic microsurgery (TEM) using the contact Nd Surg Endosc 11 485–487

    Google Scholar 

  38. C Johansson (1996) ArticleTitleEndoscopic dilation of rectal strictures Dis Colon Rectum 39 423–428

    Google Scholar 

  39. K Skreden JN Wiig HE Myrvold (1987) ArticleTitleBalloon dilation of rectal strictures Acta Chir Scand 153 615–617

    Google Scholar 

  40. PW Whitworth RL Richardson GM Larson (1988) ArticleTitleBalloon dilatation of anastomotic strictures Arch Surg 123 759–762

    Google Scholar 

  41. GK McLean GS Cooper WH Hartz DR Burke SG Meranze (1987) ArticleTitleRadiologically guided balloon dilation of gastrointestinal strictures. Part I. Technique and factors influencing procedural success Radiology 165 35–40

    Google Scholar 

  42. MC Oz KA Forde (1990) ArticleTitleEndoscopic alternatives in the management of colonic strictures Surgery 108 513–519

    Google Scholar 

  43. K Hood A Lewis (1986) ArticleTitleDilator for high rectal strictures Br J Surg 73 633–519

    Google Scholar 

  44. L Linares LF Moreira H Andrews RN Allan J Alexander-Williams MR Keighley (1988) ArticleTitleNatural history and treatment of anorectal strictures complicating Crohn’s disease Br J Surg 75 653–655

    Google Scholar 

  45. C Virgilio S Cosentino C Favara V Russo A Russo (1995) ArticleTitleEndoscopic treatment of postoperative colonic strictures using an achalasia dilator Endoscopy 27 219–222

    Google Scholar 

  46. A Werre C Mulder C van Heteren ES Bilgen (2000) ArticleTitleDilation of benign strictures following low anterior resection using Savary-Gilliard bougies Endoscopy 32 385–388

    Google Scholar 

  47. KS Venkatesh PS Ramanujam S McGee (1992) ArticleTitleHydrostatic balloon dilatation of benign colonic anastomotic strictures Dis Colon Rectum 35 789–791

    Google Scholar 

  48. AK Banerjee TK Walters R Wilkins M Burke (1991) ArticleTitleWire-guided balloon coloplasty J R Soc Med 84 136–139

    Google Scholar 

  49. M Itabashi K Hamano S Kameoka K Asahina (1993) ArticleTitleSelf-expanding stainless steel stent application in rectosigmoid stricture Dis Colon Rectum 36 508–511

    Google Scholar 

  50. E Tejero A Mainar L Fernandez R Tobio MA De Gregorio (1994) ArticleTitleNew procedure for the treatment of colorectal neoplastic obstructions Dis Colon Rectum 37 1158–1159

    Google Scholar 

  51. JC Salinas J Quintana MA De Gregorio E Insignares I Gil R Lozano (1997) ArticleTitleManagement of benign rectal stricture by implantation of a self-expanding prosthesis Br J Surg 84 674–1159

    Google Scholar 

  52. EE de Lange HA Shaffer SuffixJr (1991) ArticleTitleRectal strictures Radiology 178 475–479

    Google Scholar 

  53. M Giovannini (2000) ArticleTitleThree-dimensional endorectal ultrasound Acta Endoscopica 30 27–31

    Google Scholar 

  54. M Genna F Leopardi E Valloncini GF Veraldi (2000) ArticleTitleRisultati di staging preoperative nel cancro retalle Minerva Chir 55 409–414

    Google Scholar 

  55. C Bartram G Brown (2002) ArticleTitleEndorectal ultrasound and magnetic resonance imaging in rectal cancer staging Gastroenterol Clin North Am 31 827–839

    Google Scholar 

  56. G Gagliardi S Bayar R Smith RR Salem (2002) ArticleTitlePreoperative staging of rectal cancer using magnetic resonance imaging with external phase-arrayed coils Arch Surg 137 447–451

    Google Scholar 

  57. M Hunerbein W Pegios B Rau TJ Vogl R Felix PM Schlag (2000) ArticleTitleProspective comparison of endorectal ultrasound, three-dimensional endorectal ultrasound, and endorectal MRI in the preoperative evaluation of rectal tumors. Preliminary results Surg Endosc 14 1005–1009

    Google Scholar 

  58. PF Anseline IC Lavery VW Fazio DG Jagelman FL Weakley (1981) ArticleTitleRadiation injury of the rectum Ann Surg 194 716–724

    Google Scholar 

  59. EM Bricker WD Johnston (1979) ArticleTitleRepair of postirradiation rectovaginal fistula and stricture Surg Gynecol Obstet 148 499–506

    Google Scholar 

  60. A Ommer S Athanasiadis A Kohler E Psarakis (2000) ArticleTitleIndications for fecal diversion in treatment of high fistula-in-ano and rectovaginal fistulae Coloproctology 22 14–22

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

Garcea, G., Sutton, C.D., Lloyd, T.D. et al. Management of Benign Rectal Strictures. Dis Colon Rectum 46, 1451–1460 (2003). https://doi.org/10.1007/s10350-004-6792-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-6792-x

Keywords

Navigation