Management of benign anastomotic stenosis after rectal cancer surgery / 国际外科学杂志

ABSTRACT

Objective:To discuss the occurrence, treatment and prevention of benign anastomotic stenosis after radical resection for rectal cancer.Methods:The clinical data of 63 patients with benign anastomotic stenosis from Jan. 2016 to Dec.2020 at Department of Gastrointestinal Surgery, Renji Hospital Shanghai Jiaotong University School of Medicine, were retrospectively analyzed, including general conditions, intraoperative conditions, postoperative complications, anastomotic stenosis, treatment process and outcome. The relationship between stenosis type and treatment and outcome were analyzed.The measurement data obeying normal distribution was expressed by ( Mean± SD), and the t test was used comparison between groups. The chi-square test was used comparison between enumeration data. Results:Of all the 63 patients, 22 (34.9%) cases presented with membranous stenosis, 30 (47.6%) cases with tubular stenosis, and 11 (17.5%) cases with diffused stenosis. Three of the 9 patients with high stenosis underwent balloon dilatation through endoscopy, 3 were placed with self-expandable metal stent and the rest 3 patients underwent resection and reconstruction of the anastomosis. All the 54 patients with low stenosis underwent digital anal expansion, and finally the effective rate was 53.7% (29/54). Endoscopic balloon dilatation was successfully performed in 8 cases, including 4 cases were placed metal stent throngh endoscopy. Eight patients underwent trans-anal stricturotomy. In 5 patients with low diffused stenosis, either ileostomy was preserved or permanent colostomy was performed due to failure to treatment. There were more male patients, protective ileostomy, anastomotic leakage and low stenosis in patients failed to treatment than in the cured patients ( P>0.05). However, all the 5 patients who failed to treatment were suffered from diffused stenosis, and the difference was statistically significant compared with those who were cured ( P<0.05). Conclusions:Postoperative anastomotic stricture after anterior rectectomy requires different treatment strategies according to the location and types of stricture. Endoscopic balloon dilatation is preferred for high stenosis, and metal stents can be placed optionally. Digital anal expansion is preferred for low anastomotic stenosis, and endoscopic or minimally invasive transanal surgery is feasible if digital anal expansion fails.