Abstract
Background: Combined transanal- transabdominal resection of anastomotic stenosis has the potential to restore bowel continuity for patients with instead of suffered colorectal anastomosis stenosis. The objective of this study was to assess the treatment efficacy for patientswho underwent combined transanal- transabdominal resection of colorectal anastomosis stenosis.
Methods: We retrospectively included a cohort of consecutive patients who underwent combined transanal-transabdominal endoscopic resection for colorectal anastomosis stenosis. This study encompassed the period from August 2019 to March 2023. We gathered data pertaining to intraoperative details, mortality, postoperative complications, and the rate of stoma closure. Functional outcomes were assessed using the low anterior resection syndrome (LARS) and Wexner incontinence questionnaires.
Results: A total of 54 patients, comprising 46 men and 8 women, met the inclusion criteria. All patients exhibited anastomotic stenosis resulting from anastomotic leakage or preoperative radiotherapy. The median duration of hospitalization was 15 (11-24) days. No instance of mortality was recorded. The morbidity rate was 15%. After a total follow-up period of 48 months, stoma closure was performed in 49 patients after a median delay of 3.8 (2.5-11) months. At the end of follow-up, two patients with failed stoma closure due to poor functional outcomes of anastomosis, while three patients experienced a recurrence of anastomotic stenosis. Among the 49 patients who were available for follow-up, 35 (71.4%) reported either no or minor LARS symptoms. The median Wexner incontinence score was 8 (0-18). Notably, 13 patients achieved a Wexner incontinence score of 0. Erectile function was assessed in 28 male patients, and 18 of them reported normal postoperative erectile function.
Conclusions: Combined transanal- transabdominal endoscopic resection is an effective approach for treating colorectal anastomosis stenosis, demonstrating a high stoma closure rate, low morbidity associated with complications, and favorable long-term functional outcomes.