Management of Complete Rectal Anastomotic Stenosis: A Feasible, Safe, and Effective Approach to a Challenging Complication

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Abstract
Rectal anastomotic stricture (RAS) is a significant complication following rectal resection. Several techniques have been proposed for its management. However, treating complete strictures remains challenging. To describe a simple, safe, and effective technique for the treatment of complete RAS using a circular stapler under ileocolonoscopic guidance. A 43-year-old man underwent laparoscopic anterior resection of the rectum for a 7 cm serrated adenoma located 10 cm from the anal verge. The anastomosis was created 8 cm from the anal verge, and a protective loop ileostomy was fashioned. Histopathological analysis revealed a sessile serrated adenoma confined to the mucosa with foci of intramucosal carcinoma (TisN0). At 2 years postoperatively, delayed follow-up due to the COVID-19 pandemic revealed a complete RAS. Computed tomography (CT) with contrast administered through both the ileostomy efferent loop and the rectum demonstrated a short (< 1 cm) stricture at the anastomosis. The patient underwent transanal correction using a single-port system, assisted by colonoscopy through the ileostomy efferent loop. After circumferential stricturoplasty, a 31 mm circular stapler was used to perform reanastomosis under colonoscopic guidance. The patient had an uneventful recovery and was discharged on postoperative day 1. The ileostomy was closed after 45 days, and the patient presented only minimal symptoms of low anterior resection syndrome. Transanal stricturoplasty followed by circular stapler reanastomosis under endoscopic guidance appears to be a safe, simple, and effective approach for managing complete benign RAS. This technique may be considered in cases refractory to endoscopic dilation, in the place of redo surgery.

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