title: Anastomotic stenosis after coloanal, colorectal and ileoanal anastomosis: what is the best management?
abstract: OBJECTIVE
  To assess the results of treatment for colorectal (CRA), coloanal (CAA) or ileal pouch-anal (IPAA) anastomotic stenosis (AS).
  
  
  METHODS
  All patients operated on for AS from 1995 to 2014 were included. Success was defined as the absence of an additional surgical procedure for AS during 12 months after the last procedure and the absence of a stoma at the end of follow-up.
  
  
  RESULTS
  Fifty consecutive patients presenting with AS after CRA (n = 16, 32%), CAA (n = 18, 36%) or IPAA (n = 16, 32%), performed for colorectal cancer (n = 28, 56%), familial adenomatous polyposis (n = 5, 10%), inflammatory bowel disease (n = 8, 16%), diverticulitis (n = 4, 8%), benign colorectal neoplasia (n = 3, 6%) or other (n = 2, 4%) underwent a total of 99 procedures including digital (n = 14, 14%), instrumental (n = 38, 38%) or endoscopic dilatation (n = 5, 5%), transanal AS stricturoplasty (n = 9, 10%), transanal circular stapler resection (n = 11, 11%) or transabdominal redo-anastomosis (n = 22, 22%). Overall the per-procedure success rate was 53% (52/99). Success rates were 36% (5/14) for digital dilatation, 40% (15/38) for instrumental dilatation, 20% (1/5) for endoscopic dilatation, 64% (7/11) for circular stapler resection, 89% (8/9) for stricturoplasty and 73% (16/22) for transabdominal redo-anastomosis. After a mean follow-up of 46 months, 42/50 (84%) patients had treatment that was considered successful. Multivariate analysis identified redo-anastomosis [OR = 5.1 (95% CI: 1.4-18.7), P = 0.003] as the only independent prognostic factor for success.
  
  
  CONCLUSIONS
  AS should be managed according to a step-up strategy. Conservative procedures are associated with acceptable success rates. If these fail, transabdominal redo-anastomosis is associated with the highest probability of success.
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and University Paris VII, Clichy, France.
authors.forename: A
authors.initials: A
authors.lastname: Kraenzler
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and University Paris VII, Clichy, France.
authors.forename: L
authors.initials: L
authors.lastname: Maggiori
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and University Paris VII, Clichy, France.
authors.forename: O
authors.initials: O
authors.lastname: Pittet
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and University Paris VII, Clichy, France.
authors.forename: M S
authors.initials: MS
authors.lastname: Alyami
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and University Paris VII, Clichy, France.
authors.forename: J
authors.initials: J
authors.lastname: Prost À la Denise
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and University Paris VII, Clichy, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000236:Adenoma / Q000601:surgery; D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000601:surgery; D003082:Colectomy; D003106:Colon / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery*; D004106:Dilatation / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000601:surgery; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000601:surgery*; D016737:Proctocolectomy, Restorative; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
keywords:  ileal pouch-anal;  ileoanal; Stenosis; anastomosis coloanal; colorectal