Dilation of benign anastomotic strictures after circular stapler anastomosis using Hegar's dilators
Journal Title: Gastroenterologia Polska - Year 2008, Vol 15, Issue 2
Abstract
Introduction: The incidence of colorectal anastomotic strictures occurs in up to 30% of patients. Most of the strictures are simple benign narro-ings shorter than 1 cm that can be successfully treated by dilation or endoscopic alternatives. Aim of study: To assess the effectiveness of benign anastomotic strictures dilations after stapled colorectal/coloanal anastomosis using Hegar'sdilators. Material and methods: Between March 2003 and January 2005 we treated 8 patients (5 males and 3 females) for severe stricture of colorectal and one male patient of ileoanal anastomosis. The overall rate of either colorectal or ileoanal anastomosis stricture was 3.01%. Average age was 60.6 years. All patients underwent stapled anastomosis with circular stapler (Ethicon Endo-Surgery - INC, Johnson and Johnson Company - SDH 29). The reason for the initial surgery was rectal cancer in 7 patients, sigmoid cancer in one case and familial adenomatous polyposis (FAP) also in one case. Neoplastic changes were excluded in all patients before the definitive treatment of stenosis. The median time between the initial operation and clinical symptoms of anastomotic strictures was 10.5 (range, 4-22) months. Gynaecological Hegar's dilators (diameter of 2-24 mm) were used for dilation. Mean follow-up after dilation was 23.7 (range, 13-31) months. In all patients strictures were located within the anastomotic site. Mean stricture diameter was 4.9 mm (range, 3-7). The anastomotic stenosis was located ata mean distance of 8.8 (range, 3-13) cm from the anal verge. Results: In all patients anastomotic strictures were benign and comprised only the colorectal anastomosis in 8 patients and ileoanal anastomosis in one case. Normal defecation was restored in all patients as well as symptomatic relief was obtained. Anastomotic lumen was widened up to 15-22 mm. The mean number of required sessions was 1.2 (range, 1-2). Seven out of 9 patients required only one dilation and in 2 out of 9 patients two dilations were necessary (8 and 14 months after first dilation, respectively). No complications were observed. Conclusions: Dilation of benign anastomotic strictures following stapled anastomosis by using Hegar's dilators appeared to be safe and successful treatment. No procedure-related complications occurred. This method let us a void high-risk reoperations. Dilations may be repeated safely if necessary.
Authors and Affiliations
Radzisław Trzciński, Michał Mik, Andrzej Sygut, Ryszard Kujawski, Przemysław Galbfach, Łukasz Dziki, Adam Dziki
Keywords
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