Summary
After the use of surgical staplers had become widespread, the number of colonic postoperative stenoses was observed to have increased. Nevertheless, the clinical relevance of this observation is minimal since only 2–5% of the patients complain of chronic constipation or obstruction symptoms. In such cases medical therapy is somewhat troublesome, and surgical treatment always implies a major operation. Endoscopic dilation has proved to be a reliable, simple, and safe therapeutic alternative. Forty-two patients with evidence of stenosis of either colocolic or colorectal anastomosis underwent mechanical or pneumatic dilation in our unit: 19 patients with a temporary diverting stoma were dilated before the colostomy was removed; in the remaining 23 cases, treatment was given according to the patients' symptoms or because it was not possible to pass the anastomosis with an endoscope. The overall failure rate was 2.4%, and no morbidity or mortality was found. When the percentages of patients successfully treated in one session alone were compared (76.9% versus 51.8%), balloon dilation was found to be more effective than bougienage. In our opinion, endoscopic dilation represents the mainstay of treatment of colonic anastomotic strictures, with surgery being reserved for the rare failures, when recurrence of cancer should be suspected.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Accordi F, Sogno O, Carniato S, Fabris G, Moschino P, Coan B, Carlon CA (1987) Endoscopic treatment of stenosis following stapled anastomosis. Dis Colon Rectum 30: 647–649
Barroso AO, Azizi E, Jordan G, Alpert E (1987) Repeated balloon dilation of a severe colonic stricture. Gastrointest Endosc 33: 320–322
Beart RW, Kelly KA (1981) Randomized prospective evaluation of the EEA stapler for colorectal anastomoses. Am J Surg 141: 143–147
Bedogni G, Ricci E, Pedrazzoli C, Conigliaro R, Barbieri I, Bertoni G, Contini S, Serafini G (1987) Endoscopic dilation of anastomotic colonic stenosis by different techniques: an alternative to surgery? Gastrointest Endosc 33: 21–24
Brower RA, Freeman LD (1984) Balloon catheter dilation of a rectal stricture. Gastrointest Endosc 30: 95–97
Everett WG, Friend PJ, Forty J (1986) Comparison of stapling and hand-suture for left-sited large bowel anastomosis. Br J Surg 73: 345–348
Gordon TH, Vasilevsky CA (1984) Experience with stapling in rectal surgery. Surg Clin North Am 64: 555–565
Graffner H, Anderson L, Lowenhielm P, Walther B (1984) The healing process of anastomoses of the colon. A comparative study using single, double-layer and stapled anastomoses. Dis Colon Rectum 27: 767–771
Kissin MW, Cox AG, Wilkins RA, Kark AE (1985) The fate of the EEA-stapled anastomosis: a clinico-radiological study of 38 patients. Ann R Coll Surg Engl 67: 20–22
Kozarek RA (1986) Hydrostatic balloon dilation of gastrointestinal stenoses: a national survey. Gastrointest Endosc 32: 15–19
McGinn FP, Gartell PC, Clifford PC, Brunton FJ (1985) Staples or sutures for low colorectal anastomoses: a prospective randomized trial. Br J Surg 72: 603–605
Neufeld DM, Shemesh EI, Kodner IJ, Shatz BA (1987) Endoscopic management of anastomotic colon strictures with electrocautery and balloon dilation. Gastrointest Endosc 33: 24–26
Pan Chi Chen, Cheng Shyong Wu, Chi Sin Chang Chien, Yun-Fan Liaw (1984) YAG-laser endoscopic treatment of an esophageal and sigmoid stricture after end-to-end anastomosis stapling. Gastrointest Endosc 30: 258–259
Pietropaolo V, Viceconte GW, Bogliolo G, De Anna L, (1983) Il trattamento endoscopico delle stenosi cicatriziali post-operatorie del colon. In: Montori A (ed) Advances in digestive surgery and endoscopy. Ferri, Rome, pp 125–131
Sander R, Poesl H, Spuhler A (1984) Management of non-neoplastic stenoses of the GI tract. A further indication for Nd-YAG laser application. Endoscopy 16: 149–151
Shikata J, Shida T (1985) Experimental studies by the resin-casting method on the vascular structure of the colon following stapler anastomoses. Dis Colon Rectum 28: 341–346
Siegel JH, Yatto RP (1984) Hydrostatic balloon catheters. A new dimension of therapeutic endoscopy. Endoscopy 16: 231–236
Thies E, Lange V, Miersch WD (1983) Peranal dilatation of post surgical colonic stenosis by means of a flexible endoscope. Endoscopy 15: 327–328
Venu RP, Geenen JE, Hogan WJ, Kruidenier J, Stewart ET, Soergel KH (1984) Endoscopic electrosurgical treatment for strictures of the gastrointestinal tract. Gastrointest Endosc 30: 97–98
Waxman BP, Ramsay AH (1986) The effect of stapler diameter and proximal colostomy on narrowing at experimental circular stapled large bowel anastomosis. Aust N Z J Surg 56: 797–801
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pietropaolo, V., Masoni, L., Ferrara, M. et al. Endoscopic dilation of colonic postoperative strictures. Surg Endosc 4, 26–30 (1990). https://doi.org/10.1007/BF00591410
Issue Date:
DOI: https://doi.org/10.1007/BF00591410