Conference Proceeding - Restricted Access
Purpose/Background: Despite the advances in the surgical techniques and technology in colorectal surgery, the development of colorectal anastomotic stricture following left sided colon resection is a common problem. In some case series the incidence is estimated to be as high as 30%, some of the known risk factors for developing a stricture include anastomotic leak and ischemia, Treatment options range from frequent dilation using fingers and dilator if the stricture is low or frequent endoscopic balloon dilations, unfortunately multiple sessions may required to achieve adequate result, here we presents a case report and describe a novel approach for this common problem. Methods/Interventions: Postoperative development of colorectal anastomotic stricture is a common complication with a range of 0-30%. Colonic stricture is a bowel obstruction of the enteric system characterized by the inability to pass a 12-mm proctoscope or a larger 19-mm rigid sigmoidoscope through it. Procedures like colostomy, colonic resection, colorectal endoscopic submucosal dissection and radiation enteritis could lead to the development of these strictures. A stricture may result from multiple risk factors like inflammation, tissue ischemia, or radiation of the colonic tissue.6 Risk is noted to be higher in stapled versus handsewn colorectal anastomosis. The rate of developing stricture in stapled colorectal anastomosis is about 8% compared to 2% when it is a handsewn anastomosis. Presentation of strictures depends on location and severity. The most common presentation of a colonic stricture is altered bowel habit that could be associated with localized pain to the area of obstruction. If the stricture is complete, there is will be no passage of stool or flatus risking bowel perforation if no intervention is performed in a timely manner. Results/Outcome(s): Management of strictures depends on the patient condition during the time of his or her presentation. when surgical intervention is contemplated the etiology and location of the stricutre should be considered. If the original resection procedure was done for a malignant process, the risk of tumor recurrence should be investigated and tissue biopsy is recommended prior to any intervention. If the resection was performed for benign disease and the location of the strciture is distal defined as narrowing within 10 Centimeters of the anal verge, the stricture can be effectively treated with frequent dilatation using fingers or dilators of different sizes. However, if the stricture is located higher up, endoscopic balloon dilatation can a viable option with very high success rate. However Endoscopic dilatation requires the ability to pass a guide wire through the narrowed segment of the colon under fluoroscopic guidance, Very minimum morbidity are associated with this procedure. Complications of endoscopic dilatation based on rate of occurrence include (restenosis, perforation and abscess formation). Other methods can be used if dilatation is unsuccessful include a metallic stent that can be deployed across the area of striction to keep the colon open. Conventional surgical approach whether laparoscopic or open offer long term cure, surgical options include complete resection and revision of the anastomosis or strictureplasty, higher morbidity and mortality are associated with anytype of transabdominal surgical approach and the risk of stoma should not be underestimated especially in unprepared bowel. Conclusions/Discussion: Another option is a surgical resection of the stricture (strictureplasty) via transanal approach as described above. We believe our approach can be safe and as effective as the open or laparoscopic transabdominal surgical approach provided we are dealing with favorable anatomy and stricture within our stapler reach.
Turaihi H, Wasvary H, Ziegler M. Trans-anal strictureplasy: A novel approach to a relatively common problem. Abstract presented at: American Society of Colon and Rectal Surgeons (ASCRS) 2019 Annual Scientific Meeting, 2019 Cleveland, OH, June 1-5; Cleveland, OH.