title: Colorectal anastomotic stricture: is it associated with inadequate colonic mobilization?
abstract: BACKGROUND
  Anastomotic stricture or stenosis is a well-described complication of intestinal anastomosis. The incidence of stricture after colorectal anastomosis ranges from 0 to 30 %. The aim of this study was to identify possible factors related to postoperative colorectal anastomotic stricture and to indicate reoperative surgery outcomes.
  
  
  METHODS
  After institutional review board approval, medical records were reviewed for patients who underwent surgery for colorectal anastomotic stricture at Cleveland Clinic Florida between January 2001 and December 2010. The main outcome measures were demographics, indications for initial surgery, body mass index, comorbidities, previous treatment, level of anastomosis, history of radiotherapy, and operative data for the reoperative surgery.
  
  
  RESULTS
  Nineteen patients (15 males) were eligible for the study. Nine patients had a diagnosis of cancer, 7 of whom received radiotherapy. The initial surgeries were low anterior resection (n = 9; 47.4 %), high anterior resection (n = 9; 47.4 %), and sigmoidectomy (n = 1; 5.2 %). Six patients (31.6 %) had anastomotic leak after initial surgery. The majority of the patients (n = 17; 89.5 %) had an intact splenic flexure, inferior mesenteric artery, and inferior mesenteric vein. In all patients, full mobilization of the splenic flexure and high ligation of the mesenteric vessels was performed. Seven patients (36 %) developed postoperative complications. Over a mean follow-up of 24.3 months, there was no recurrence of anastomotic stricture.
  
  
  CONCLUSIONS
  An intact splenic flexure and mesenteric vessels were the most prevalent in patients who underwent reoperation at our institution. Full mobilization of the splenic flexure, high ligation of the mesenteric vessels, anastomotic stricture resection, and re-anastomosis can be successfully performed with satisfactory outcomes.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hiranyakas
authors.forename: G
authors.initials: G
authors.lastname: Da Silva
authors.forename: P
authors.initials: P
authors.lastname: Denoya
authors.forename: S
authors.initials: S
authors.lastname: Shawki
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D044684:Colon, Transverse / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome