Benign anastomotic strictures after oncologic rectal cancer surgery. Results of treatment with hydrostatic dilation

Abstract Introduction Benign anastomotic strictures after rectal cancer surgery are common and their treatment can vary from conservative measures to surgical resection. Patients and methods Between March 2001 and August 2008, 422 patients with rectal cancer underwent anterior resection and 83.8% were treated with primary anastomosis. Anastomotic stricture has been defined as the inability to pass a colonoscope. Hydrostatic balloon dilation was performed. Results of success and failure dilation were assessed. Results Twenty-six patients (7.34%) with anastomotic stricture were treated; 16 men and 10 women, with a median age of 66 years (57–74). A total of 26 anterior resections were performed, as well as 10 end-to-end anastomosis, 10 side-to-end, 4 j-pouch and 2 pouch coloplasties. The median stricture height was 10 cm (4–12). Thirteen patients had preoperative radiotherapy (50%), and 9 patients had an ileostomy (34.7%). The median time of diagnosis was 6 months (3–10). The diagnosis was made by: rectal digital examination in 19.2%, colonoscopy 23.1% and clinical symptoms in 57.7%. The median number of dilation sessions required was 2 (1–4). The median of follow-up was 39 months (23 to 49). Results were successful 88.5% and unsuccessful in 11.5%. Morbidity was 3.8% (one perforation after dilation). There was no mortality. Conclusions Benign anastomotic strictures after rectal cancer surgery are frequent (7.05%), develop symptoms (52.9%) and can be successfully treated by hydrostatic dilation in more than 88% patients.