Dilation of benign strictures following low anterior resection using Savary-Gilliard bougies

Background and Study Aims: Benign anastomotic strictures occur in up to 22 % of patients after colorectal resections. Initially, treatment for these s trictures was surgical, but nowadays endoscopic dilation techniques are pre ferred. This study was conducted to assess the efficacy of dilation using S avaryGilliard bougies, Patients and Methods: From 1987 to 1994, 256 consecutive patients underwent low anterior resection (LAR), Twenty-one patients (8.2%) developed a stric ture of the colorectal anastomosis, Follow-up data were available for 18 of these patients. The patients were treated using endoscopic Savary dilation , with bougies of increasing diameters (10-19 mm), The mean follow-up perio d was 19 months (1-60 months). Results: Stricture symptoms presented after a mean period of 7.7 months aft er LAR, In three of the 18 patients, the stenosis was caused by local recur rence, and these patients were excluded from further evaluation, Normal def ecation was restored in 10 of the remaining 15 patients, and symptoms disap peared. In five patients, there was only partial improvement, but only thre e of them required another type of treatment. Of four patients who received radiotherapy and developed a strictured anastomosis, two had successful di lations. A normal defecation pattern was never regained if more than three dilations were necessary. No complications caused by Savary dilation were o bserved, Conclusions: In this study population, Savary dilation appeared to be a saf e and effective treatment for benign anastomotic strictures after LAR, All successfully treated patients (ten of 15) required no more than three dilat ions. Two other patients had partial success. Only three patients required another form of treatment (two endoscopic, one surgical).