Management of Anastomotic Stricture

  • Lindsey E. Richards
  • Sarah Y. BoostromEmail author
  • James W. Fleshman


Stricture is a common postoperative complication associated with colorectal surgery. Although some strictures are easily treated, some may cause significant symptoms, including constipation or watery diarrhea, feelings of incomplete evacuation, abdominal distention, and pain, all which have the potential to greatly impede the quality of life, depending on the location. While there are successful treatment options available from balloon dilation to reoperative surgery, several risk factors have been identified that can be minimized both in the preoperative and in the postoperative periods, thus reducing the chance of anastomotic stricture formation. This chapter addresses the presentation, diagnosis, and risk factors for colorectal anastomotic (CRA) strictures as well as the management and treatment.


Colorectal anastomotic strictures Resection Malignancy Inflammatory Tension Reoperative surgery Balloon dilation Bougies Stents (SEMS) Memory shaped alloy 


  1. 1.
    American Cancer Society. Colorectal facts & figs. 2011–2013. Behavioral risk factor surveillance system public use data tapes 2006 and 2008. National Center for chronic disease prevention and health promotion, centers for disease control and prevention.Google Scholar
  2. 2.
    Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol E, Panaccione R, Ghosh S, Barkema HW, Kaplan GG. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.CrossRefPubMedGoogle Scholar
  3. 3.
    Lefèvre JH, Bretagnol F, Maggiori L, Ferron M, Alves A, Panis Y. Redo surgery for failed colorectal or coloanal anastomosis: a valuable surgical challenge. Surgery. 2011;149(1):65–71.CrossRefPubMedGoogle Scholar
  4. 4.
    Dietz DW, Bailey HR. Postoperative complications. In: Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD, Editors. The ASCRS textbook of colon and rectal surgery. New York: Springer; 2007. p. 144.Google Scholar
  5. 5.
    Schlegel RD, Dehni N, Parc R, Caplin S, Tiret E. Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum. 2001;44(10):1464–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Polese L, Vecchiato M, Frigo AC, Sarzo G, Cadrobbi R, Rizzato R, Bressan A, Merigliano S. Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn? Colorectal Dis. 2012;14(3):e124–8CrossRefPubMedGoogle Scholar
  7. 7.
    Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1014 patients. J Am Coll Surg. 1997;185(2):105–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Hiranyakas A, Da Silva G, Denoya P, Shawki S, Wexner SD. Colorectal anastomotic stricture: is it associated with inadequate colonic mobilization? Tech Coloproctol. 2013;17(4):371–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, Michelassi F, Charlson ME, Milsom JW. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg. 2013;257(1):108–13.CrossRefPubMedGoogle Scholar
  10. 10.
    Hall NR, Finan PJ, Stephenson BM, Lowndes RH, Young HL. High tie of the inferior mesenteric artery in distal colorectal resections—a safe vascular procedure. Int J Colorectal Dis. 1995;10(1):29–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Neutzling CB, Lustosa SA, Proenca IM, da Silva EM, Matos D. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. 2012;2:CD003144. doi:10.1002/14651858.CD003144.pub2.PubMedGoogle Scholar
  12. 12.
    Davis B, Rivadeneira DE. Complications of colorectal anastomoses leaks, strictures, and bleeding. Surg Clin North Am. 2013;93(1):61–87.CrossRefPubMedGoogle Scholar
  13. 13.
    Klos CL, Safar B, Jamal N, Hunt SR, Wise PE, Birnbaum EH, Fleshman JW, Mutch MG, Dharmarajan S. Obesity increases risk for pouch-related complications following restorative proctocolectomy with Ileal pouch-anal anastomosis (IPAA). J Gastrointest Surg. 2014;18(3):573–9.Google Scholar
  14. 14.
    Shackelford RT. Low anterior resection. In: Zuidema GD, editor. Shackelford’s surgery of the alimentary tract. Vol. IV. Colon. Philadelphia: W. B. Saunders Co.; 1996. p. 241.Google Scholar
  15. 15.
    Kwon YH, Jeon SW, Lee YK. Endoscopic management of refractory benign colorectal strictures. Clin Endosc. 2013;46(5):472–5.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Kim PH, Song HY, Park JH, Kim JH, Na HK, Lee YJ. Safe and effective treatment of colorectal anastomotic stricture using a well-defined balloon dilation protocol. J Vasc Interv Radiol. 2012;23(5):675–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Virgilio C, Cosentino S, Favara C, Russo V, Russo A. Endoscopic treatment of postoperative colonic strictures using an achalasia dilator: short-term and long-term results. Endoscopy. 1995;27:219–22.Google Scholar
  18. 18.
    Lemberg, B, Vargo JJ. Balloon dilation of colonic strictures. Am J Gastroenterol. 2007;102:2123–25.CrossRefPubMedGoogle Scholar
  19. 19.
    Genser L, Manceau G, Karoui M, Breton S, Brevart C, Rousseau G, Vaillant JC, Hannoun L. Postoperative and long-term outcomes after redo surgery for failed colorectal or coloanal anastomosis: retrospective analysis of 50 patients and review of the literature. Dis Colon Rectum. 2013;56(6):747–55.CrossRefPubMedGoogle Scholar
  20. 20.
    Lamazza A, Fiori E, De Masi E, Scoglio D, Sterpetti AV, Lezoche E. Self-expanding metal stents for treatment of anastomotic complications after colorectal resection. Endoscopy. 2013;45(6):493–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Toth E, Nielsen J, Nemeth A, Wurm Johansson G, Syk I, Mangell P, Almqvist P, Thorlacius H. Treatment of a benign colorectal anastomotic stricture with a biodegradable stent. Endoscopy. 2011;43(Suppl. 2) UCTN:E252–3. doi:10.1055/s-0030-1256511.CrossRefPubMedGoogle Scholar
  22. 22.
    Alves A, Panis Y, Mantion G, Kwiatkoswki F, Slim K, Association Française de Chirurgie. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study in 1049 patients. Ann Surg. 2007;246:91–6.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Matthiessen P, Hallbook I, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.Google Scholar
  24. 24.
    Grassi N, Cipolla C, Bottino A, Graceffa G, Montana L, Privitera C, Grassi R, Latteri MA. Validity of shape memory NiTi colon ring BioDynamix ColonRing™ (or NiTi CAR 27™) to prevent anastomotic colorectal strictures. Preliminary results. G Chir. 2012;33(5):194–8.PubMedGoogle Scholar
  25. 25.
    Berho M, Fleshman J, Wexner S, Botero-Anug A, Pelled, D. Histopathological advantages of compression ring anastomosis healing as compared to stapled anastomosis in a porcine model: a blinded comparative study. Accepted for publication. Dis Colon Rectum. 2014;57(4):506–13.CrossRefPubMedGoogle Scholar
  26. 26.
    Fingerhut A, Hay JM, Elhadad A, Lacaine F, Flamant Y. Supraperitoneal colorectal anastomosis: hand-sewn versus circular staples—a controlled clinical trial. French associations for surgical research. Surgery. 1995;118(3):479–85.CrossRefPubMedGoogle Scholar
  27. 27.
    Sarker SK, Chaudhry R, Sinha VK. A comparison of stapled vs handsewn anastomosis in anterior resection for carcinoma rectum. Indian J Cancer. 1994;31(2):133–7.PubMedGoogle Scholar
  28. 28.
    Elhadad A. Colorectal anastomosis: manual or mechanical? A controlled multicenter study. Chirurgie. 1990;116(4–5):425–8.PubMedGoogle Scholar
  29. 29.
    Kracht M. The best anastomoses after colonic resection. Ann Chir. 1991;45(4):295–8.PubMedGoogle Scholar
  30. 30.
    Thiede A, Schubert G, Poser HL, Jostarndt L. Technic of rectum anastomoses in rectum resection. A controlled study: instrumental suture versus hand suture. Chirurg. 1984;55(5):326–35.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Lindsey E. Richards
    • 1
  • Sarah Y. Boostrom
    • 1
    Email author
  • James W. Fleshman
    • 2
  1. 1.Baylor University Medical CenterDallasUSA
  2. 2.Department of SurgeryBaylor University Medical CenterDallasUSA

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