Endoscopy 2018; 50(04): S157
DOI: 10.1055/s-0038-1637509
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

A RETROSPECTIVE AUDIT OF RECTAL STRICTURES IN PATIENTS WITH LOW RECTAL CANCER WHO HAVE UNDERGONE AN INTER-SPHINCTERIC RESECTION (ISR)

S Mazumdar
1   Tata Memorial Hospital, Department of Digestive Diseases and Clinical Nutrition, Mumbai, India
,
P Patil
1   Tata Memorial Hospital, Department of Digestive Diseases and Clinical Nutrition, Mumbai, India
,
S Mehta
1   Tata Memorial Hospital, Department of Digestive Diseases and Clinical Nutrition, Mumbai, India
,
A Saklani
2   Tata Memorial Hospital, Department of Surgical Oncology, GI Division, Mumbai, India
,
A Desouza
2   Tata Memorial Hospital, Department of Surgical Oncology, GI Division, Mumbai, India
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

 

Aims:

Inter-sphincteric resection (ISR) is currently the surgery of choice for patients with low rectal cancer for sphincter preservation. Following ISR, many patients develop anastomotic strictures which need dilatation before stoma closure (SC) can be performed. We present a retrospective analysis of dilatation of anastomotic strictures in post ISR patients.

Methods:

150 patients underwent an ISR between June 2013 -April 2017 of which 102 were referred for endoscopy prior to stoma closure. Prospectively maintained endoscopy database was analysed to evaluate the number rectal strictures, dilatations done, and outcomes. Strictures were classified as mild, moderate, and severe (Milsom JW et al, 1986)

Results:

30 patients (29.4%) had a stricture. (9- mild; 21- moderate to severe). Dilatation was done using Savary-Gilliard dilators (SGD). 4 patients with mild stricture underwent pre-SC dilatation while rest underwent upfront SC, of which 3 underwent on table dilatation. 19 patients with moderate to severe strictures underwent pre-SC dilatation, 1 patient underwent on table dilatation during SC and 1 patient underwent post-SC dilatation. An average of 3 dilatation sessions were required (range: 1 – 9) and median dilatation diameter was 16 mm (range: 12 – 20 mm).

Stoma closure was not done in 7 patients with a stricture (2- poor sphincter tone, 4 – refractory stricture and 1-local cancer recurrence). 4 patients (17%) developed recurrent stricture post-SC. They underwent repeat dilatation (mean 3 sessions, median maximum dilatation diameter 16 mm). There were no complications associated with the dilatations.

Conclusions:

29% of ISR patient develop anastomotic strictures which are moderate to severe in most and require pre-SC dilatation. 17% require a repeat dilatation after SC. The effect of time to SC on stricture rate and functional outcomes of those who required dilatation need to evaluated prospectively.