Results of reoperations in colorectal anastomotic strictures.

PURPOSE: The incidence of colorectal anastomotic strictures varies from 3 t o 30 percent. Most of these anastomotic strictures are simple narrowings sh orter than 1 cm that can be successfully treated by dilation or endoscopic alternatives. However, up to 28 percent of patients will require surgical c orrection. This can be technically difficult, with the possibility of a per manent colostomy. This study reports the outcomes after operative treatment of severe strictures of colorectal anastomoses. METHODS: From August 1992 to October 1996, 27 patients were referred for surgical treatment of severe rectal anastomotic strictures. The reasons for the initial surgery were as follows: rectal cancer (13), diverticular disease (7), Hirschsprung's dise ase (2), rectal endometriosis (2), uterine carcinoma with rectal invasion ( 1), ruptured abdominal aortic aneurysm with rectosigmoid necrosis (1), and rectovaginal fistula (1). There were 15 (56 percent) stapled anastomoses, a nd 21 (78 percent) patients had developed a postoperative leak. RESULTS: Th e median time between initial surgery and diagnosis of the stenosis was 7.2 (range, 1-24) months and between the last operation and referral was 15.1 (range, 1-44) months. Stenosis was located at a mean distance of 9.5 (range , 4-15) cm from the anal verge. Eleven patients (41 percent) had been unsuc cessfully dilated before referral. Surgical correction of the stenosis requ ired 7 colorectal anastomoses for upper rectal anastomotic strictures and 2 0 coloanal anastomoses for middle and lower rectal strictures (19 Soave's p rocedures and 1 colon J-pouch-anal anastomosis). Intestinal continuity,was restored in all cases. After a mean follow-up of 28.7 +/- 14 months, no rec urrences were detected and functional results were satisfactory. CONCLUSION S: Resection of the stenosis and construction of a new colorectal anastomos is can be performed successfully for upper rectal anastomotic stricture. Fo r a stenosis located in the middle and lower rectum, Soave's procedure offe rs a good alternative, with satisfactory long-term functional results. Whic hever technique is used, a permanent colostomy should rarely be required.