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Transanal and Transabdominal Combined Endoscopic Redo Surgery for Benign Rectal Anastomotic Stenosis: Multicenter
Zhanzhen Liu1,2,3, Tenghui Ma1,2,3, Jianbin Xiang4
1Department of General Surgery (Colorectal Surgery), the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Background:
Benign rectal anastomotic stenosis after sphincter-preserving rectal cancer surgery remains a difficult reconstructive problem, particularly in a fibrotic pelvis.
Objective:
To evaluate outcomes and factors associated with anastomosis-related failure after transanal and transabdominal combined endoscopic redo surgery for benign rectal anastomotic stenosis.
Design:
Retrospective multicenter observational cohort study.
Settings:
Three tertiary colorectal referral centers.
Patients:
Among 239 screened patients with anastomotic stenosis, 149 had benign rectal anastomotic stenosis after rectal cancer surgery and were included in the analysis.
Main Outcome Measures:
Anatomical success, restoration of bowel continuity, postoperative morbidity, and factors associated with anastomosis-related failure.
Results:
The cohort included 149 patients, of whom 127 were men (85.2%). Mean age was 58.7 ± 9.9 years, and the mean interval from index surgery to redo surgery was 23.3 ± 28.9 months. Median follow-up was 27 months (IQR, 12-52). Anatomical success was achieved in 134 patients (89.9%), and bowel continuity was restored in 122 patients (81.9%). Anastomosis-related failure occurred in 15 patients (10.1%). In exploratory multivariable Firth penalized logistic regression, a preexisting chronic anastomotic defect was associated with anastomosis-related failure (adjusted OR, 3.249; 95% CI, 1.083-11.404; p = 0.035). Postoperative morbidity occurred in 34 patients (22.8%): Clavien-Dindo Grade I to II and grade III complications occurred in 17 patients each (11.4% each). No grade IV complications or 90-day deaths occurred.
Limitations:
The retrospective design, potential selection bias, small number of failure events, and heterogeneity in surgical techniques and perioperative management across centers may limit generalizability.
Conclusions:
Transanal and transabdominal combined endoscopic redo surgery was associated with high rates of anatomical success and restoration of bowel continuity, with acceptable morbidity. A preexisting chronic anastomotic defect was associated with anastomosis-related failure and should be considered during patient selection and counseling. See Video Abstract.
