Colorectal Anastomotic Strictures Research Articles

Combined Radial Incision and Steroid Injection for Refractory Colorectal Stenosis After Pull-Through Surgery in Hirschsprung Disease: An Innovative Conservative Treatment.

Anastomotic stenosis after pull-through surgery remains a challenge in the management of Hirschsprung disease. Based on the management of esophageal stenosis, we evaluated the efficacy of combined radial incision and steroid injection for the treatment of refractory colorectal anastomotic stenosis after pull-through. Combined radial incision and steroid injection is an alternative conservative treatment of refractory anastomotic stenosis after pull-though for Hirschsprung disease, avoiding a potential complicated redo pull-though surgery. We included patients with recto-sigmoid Hirschsprung disease that developed a refractory anastomotic stenosis after a laparoscopic-assisted Swenson pull-through at Robert-Debré Children University Hospital, Paris, France. Refractory stenosis was defined as obstructive symptoms associated with an anastomotic stenosis upon rectal exam without improvement after serial anal dilatations. Under general anesthesia, an injection of 10mg delayed-action steroid per quadrant was combined with a radial incision of the stenosis using monopolar cautery. Combined radial incision and steroid injection was performed in 4 children, for either early or late refractory stenosis. This resulted in improvement of refractory anastomotic stenosis, avoiding a redo pull-through in 75% of patients. One child presented with transient improvement after combined radial incision and steroid injection but developed recurrent stenosis despite additional combined radial incision and steroid injection and redo pull-through. The median follow-up was 29 months. We observed a clinical improvement in all the patients after combined radial incision and steroid injection. Steroids injection should be considered as a potential alternative therapy for anastomotic stenosis.

Comparison of lumen-apposing metal stents versus endoscopic balloon dilation for the management of benign colorectal anastomotic strictures

Background and aimsLimited data exist evaluating lumen apposing metal stents (LAMS) with endoscopic balloon dilation (EBD) for the treatment of benign colorectal anastomotic strictures (BCAS). This study compares outcomes of both interventions. MethodsPatients with left-sided BCAS treated with LAMS vs. EBD were identified retrospectively. The primary outcome was a composite of crossover to another intervention to achieve clinical success or recurrence requiring reintervention. ResultsTwenty-nine patients (11 LAMS; 18 EBD) were identified, with longer follow-up in the EBD group (734 vs. 142 days, p=0.003). No significant differences were found in the composite outcome, technical success, clinical success, or components of composite outcome. With LAMS, there was a nonsignificant trend toward fewer procedures (2.4 vs. 3.3, p=0.06) and adverse events (0 vs. 16.7%, p=0.26). ConclusionsLAMS appears to be as effective as EBD for the treatment of BCAS but may require fewer procedures and may be safer than EBD.

Alternative Approach in Colorectal Anastomotic Stricture: Bougie Dilatation

Dear Editor, Anostomotic stricture (AS) is seen in 2-30% of patients after colorectal surgery. Various factors such as tissue ischaemia, anastomotic leakage and radiotherapy have been suggested in its pathogenesis [1,2]. Endoscopic methods (balloon dilatation, bougie dilatation, stents, endoscopic electroincision), digital dilatation, surgical methods (stapler stricturoplasty, transanal circular stapler resection, transabdominal redo-anastomosis) and corticosteroids are used in AS [3,4]. Surgery is generally preferred in complete/near complete AS [1]. Stents; the benefit of stents in AS after oncological surgery has not been shown [3]. However, Philip BC Pangg et al. treated near-total AS non-operatively with the colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a hot lumen metallic stent [5]. We applied 3-stage bougie dilation to the patient with near complete anastomotic stricture. A 59-year-old female patient who underwent laparoscopic anterior resection due to sigmoid colon tumor was followed up with complaints of abdominal swelling, intermittent abdominal pain and difficulty in defecation. One month later, when colonoscopy was performed, near complete anastomotic stricture was observed. Bougie dilatation was performed with maloney flexible bougie dilators under wire guidance. Bougie dilatation was performed 3 times with fifteen days intervals. After the first (33, 36 and 42 F) and the second bougie dilatation (36, 42 F), the upper segment of the anastomotic stricture was reached by gastroscopy. After dilatation with a bougie (42, 45 F) for the third time, the colonoscope was easily passed through the anastomosis line to the upper segment. Six months later, colonoscopy was performed and the proximal part of the anastomosis was easily passed without the use of bougie dilators. Balloon dilatation is the first method used in AS. However, several repetitions are necessary for the success of the procedure. In addition, the risk of perforation increases when the stricture diameter is <5 mm and length >1 cm. The chances of success in AS are lower compared to bougie dilatation. Endoscopic electroincision is recommended in failure of balloon dilatation. Digital dilatation: used in distal anorectal anostamotic strictures. Corticosteroid application: very large studies are not available. Bougie dilatation in AS provides tactile feedback, allowing the amount of resistance to the passage of the dilator to be estimated and perforation to be avoided. Bougie dilatation method is simple, inexpensive and low risk of complications. Especially Maloney flexible silicone bougie minimise the risk of complications. Bougie dilatators can remain intact for many years and can be reused. But balloon dilatators are not reused. Surgical methods are used in 3-4% (complete/near complete AS) in the failure of endoscopic methods. But mortality risk is high [1,4-6]. Therefore, the alternative method of Philip BC Pang et al. can be applied [5]. However, due to limited endoscopic ultrasonography (EUS) centers, gradual dilatation can be performed with flexible bougie dilators in case of anastomosis stricture. Yours Sincerely

Snare-tipped endoscopic radical incision and cutting for postoperative colorectal anastomotic stricture.

Snare-tipped endoscopic radical incision and cutting for postoperative colorectal anastomotic stricture.

Endoscopic-Assisted Transanal Minimally Invasive Surgery to Restore Patency of a Benign Colorectal Anastomotic Stricture.

Endoscopic-Assisted Transanal Minimally Invasive Surgery to Restore Patency of a Benign Colorectal Anastomotic Stricture.

Balloon dilation and electrodestruction for colorectal anastomosis strictures

AIM: to assess results of balloon dilatation (BD) and electric destruction (ED) for strictures of colorectal anastomoses.PATIENTS AND METHODS: the prospective cohort study included 69 patients with colorectal anastomotic strictures. Thirty-two of them underwent endoscopic balloon dilatation, 37 — electric destruction of scar tissue using a spherical monopolar electrode.RESULTS: the recurrence rate of the anastomotic stricture in the BD group was 3 times higher than after ED (OR = 2.9; 95% CI: 0.7–11.1; p = 0.04). The independent factor of stricture recurrence was the extent of stricture > 11 mm (OR = 11.8; 95% CI: 1,57–123,5; p = 0.02).CONCLUSION: electric destruction and balloon dilatation are effective and safe methods for strictures of colorectal anastomoses. The independent factor recurrence risk of the stricture was the extent of the scar narrowing more than 11 mm long.

Risk Factors Associated with the Development of Colorectal Anastomotic Strictures Prior to Diverting Loop Ileostomy Reversal.

Anastomotic strictures represent a major source of morbidity in colorectal surgery with an incidence reported up to 30%. Despite this, the mechanism by which strictures develop remains unclear. This study aims to determine the incidence of colorectal anastomotic strictures and associated risk factors among a series of diverted patients. A retrospective chart review was conducted of 142 patients over a 7-year period at a single institution after colorectal resection with anastomosis and diverting ileostomy creation re-examined with postoperative endoscopy. One patient was removed due to anastomotic tumor recurrence. Patient and technical factors were examined for significance using chi-square analysis. Logistic regression was used to perform multivariate analysis to estimate odds ratio (OR) and 95% confidence intervals (CI). Among 141 patients, 14.1% (20 patients) developed strictures detected on endoscopy. Strictures were observed in a greater percentage of women than men (21.2% vs 8%, P = .025). 30.6% of patients who underwent resections for diverticulitis developed strictures while those with neoplastic lesions and other indications had stricture rates of 6.8% and 17.6%, respectively (P = .002). Anastomoses performed during a colostomy reversal were associated with a higher stricture rate (OR 4.23, 95% CI 1.37-13.40, P = .012). Anastomoses performed with a 28/29mm EEA circular stapler demonstrated a significantly higher stricture rate versus a 31/33mm stapler (OR 7.21, 95% CI 1.23-155.58, P = .045). Our data reveal that female sex, history of diverticulitis, anastomoses performed in the setting of colostomy reversal, and smaller stapler size are associated with a higher rate of anastomotic stricture.

AB174. SOH21AS184. Biodegradable polydioxanone stenting: a useful tool in the management of recurrent colorectal anastomotic strictures failing to respond to endoscopic balloon dilation

Background: Post-operative anastomotic stricture is a common complication of colorectal surgery. It is well established that endoscopic dilation is the first line option in managing these colorectal strictures. However, it is unclear what is the most suitable management of strictures not responding to endoscopic dilation.

Endoscopic balloon dilation of colorectal strictures complicating Crohn’s disease: a multicenter study

IntroductionWhile endoscopic balloon dilation (EBD) is widely used to manage ileal strictures, EBD of colorectal strictures remains poorly investigated in Crohn’s disease (CD). MethodsWe performed a retrospective study that included all consecutive CD patients who underwent EBD for native or anastomotic colorectal strictures in 9 tertiary centers between 1999 and 2018. Factors associated with EBD failure were also investigated by logistic regression. ResultsFifty-seven patients (25 women, median age: 36 years (InterQuartile Range, 31-48) were included. Among the 60 strictures, 52 (87%) were native, 39 (65%) measured < 5 cm and the most frequent location was the left colon (27%). Fifty-seven (95%) were non-passable by the scope and 35 (58%) were ulcerated. Among the 161 EBDs performed (median number of dilations per stricture: 2, IQR 1-3), technical and clinical success were achieved for 79% (n = 116/147) and 77% (n = 88/115), respectively. One perforation occurred (0.6% per EDB and 2% per patient). After a median follow-up of 4.3 years (IQR 2.0-8.4), 24 patients (42%) underwent colonic resection and 24 (42%) were asymptomatic without surgery. One colon lymphoma and one colorectal cancer were diagnosed (3.5% of patients) from endoscopic biopsies and at the time of surgery, respectively. No factor was associated with technical or clinical success. ConclusionEDB of CD-associated colorectal strictures is feasible, efficient and safe, with more than 40% becoming asymptomatic without surgery.

Uncovered self-expandable metal stents for the treatment of refractory benign colorectal anastomotic stricture

Self-expandable metal stent (SEMS) placement has been suggested as a therapeutic modality for treating benign colorectal strictures. Covered stents are generally used, given the concerns regarding the efficacy and safety of uncovered stents. Hence, few studies have evaluated the efficacy and safety of uncovered SEMSs (UCSEMSs) in patients with refractory benign colorectal anastomotic strictures. In this study, 12 patients with postoperative benign symptomatic anastomotic strictures refractory to pneumatic dilation (range, 2–9) and transient indwelling-covered SEMSs were treated using UCSEMS. All enrolled patients were men (mean age, 61 years). Stent placement was successful in all 12 patients, and early clinical success was achieved in 11 (92%) patients. Four patients (25%) showed successful clinical outcomes without further intervention, but eight patients (75%) were clinically unsuccessful, and showed stricture recurrence or functional obstructive symptoms. Three patients underwent surgery, and the remaining five patients required repeat stent procedures. Despite the high reobstruction rate, the median follow-up period after UCSEMS placement was 16.7 months, demonstrating that UCSEMS may be able to achieve medium-term symptom relief without any complications. Therefore, UCSEMS may be an alternative option in exceptional circumstances in carefully selected patients, where invasive surgical treatments, such as stoma diversion, are not an option, thereby improving patients’ quality of life.

S2321 Use of a Lumen-Apposing Metal Stent for a Colo-Colonic Stricture in the Time of COVID-19

INTRODUCTION: Anastomotic strictures are a known complication of colon resections. Risk factors include neoadjuvant chemo-radiation, anastomotic leak, diverting stoma and stapled anastomosis. Endoscopic balloon dilation is the first line intervention for anastomotic strictures but often requires several treatment sessions and associated healthcare system exposure. We describe a case of a colorectal anastomotic stricture treated with a lumen apposing metal stent (LAMS) with the purpose of decreasing frequency of endoscopic therapy during the initial outbreak of COVID-19. CASE DESCRIPTION/METHODS: A 51 year old female presented for management of a colo-colonic anastomotic stricture. She underwent a low anterior resection for stage III rectal cancer, complicated by an anastomotic leak requiring a diverting loop ileostomy. She then completed adjuvant XRT and FOLFOX therapy. She presented for evaluation 6 months after the creation of her loop ileostomy to consider reversal. During endoscopy, a severe stricture was found which could not be traversed even with a 15 Fr gastroscope. Initial dilation to 10mm with a balloon dilator was successful. One week later, the stricture was improved but still severe. A 15 mm by 10 mm LAMS was placed with the intent of decreasing the number of required procedures and healthcare system exposure during the initial outbreak of COVID-19. The stent was removed 6 weeks later, and the underlying stricture was markedly improved to a diameter of 15 mm, easily traversable with a gastroscope. The patient did not experience any complications while the stent was in place and was able to proceed with planning for ostomy reversal. DISCUSSION: Endoscopic balloon dilation is the initial intervention for anastomotic strictures. Serial balloon dilations usually require multiple procedures to achieve a durable response. With the uncertainty caused by the recent outbreak of COVID-19, many physicians and patients are looking for ways to decrease exposure to healthcare centers. Although LAMS are approved for the management of pancreatic fluid collections, they have been described as an alternative therapy for luminal GI strictures. This case demonstrates early adoption of LAMS with successful luminal dilation of an anastomotic stricture during the COVID-19 pandemic in an effort to decrease healthcare exposure and PPE use during an unprecedented time.Figure 1.: Colo-colonic anastomotic stricture prior to dilation.Figure 2.: LAMS 6 weeks after initial placement.Figure 3.: Stricture after LAMS removal.

Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results

BackgroundPostoperative colorectal anastomotic strictures are quite common. As such, many techniques have been available to address such a problem, one of which is endoscopic dilation. The aim of the present study was to evaluate the long-term outcomes following endoscopic dilation using a multidiameter balloon.MethodsA retrospective study was conducted on patients with postoperative anastomotic stenosis treated with endoscopic dilation using a multidiameter balloon at our institution, in January 2005–December 2019 were retrospectively reviewed, excluding those with tumor recurrence. Perioperative factors, complications, and recurrence rates were analyzed.ResultsThere were 40 patients, (22 males and 18 females, mean age 64.6 ± 10.7 years, range 33–84 years). The median follow-up period was 56 months (interquartile range 22.5–99 months). Only 1 complication occurred, micro-perforation due to guided wire injury, which was managed conservatively. Five (12.5%) patients developed restenosis and underwent repeat balloon dilation. None of the five recurrences required more aggressive management, such as redo anastomosis.ConclusionsEndoscopic multidiameter balloon dilation is a safe and effective method for treating benign colorectal anastomotic strictures.

Recanalization of a complete colorectal anastomotic stenosis: an application of the Hot AXIOS stent

A 43-year-old woman underwent emergency surgery for a neoplastic colonic perforation. A sigmoidectomy with colorectal anastomosis protected by an ileostomy was performed. Pathological findings showed a well differentiated pt4N1aM0 adenocarcinoma. FOLFOX adjuvant chemotherapy was given. At endoscopy, 3 months later, a complete anastomotic stenosis was detected ([Fig. 1]). After discussion with the surgical team, it was decided to proceed with endoscopic management using a lumen-apposing metal stent (LAMS), as described in previous cases[1] [2].

Non-operative Management of Benign Colorectal Anastomotic Stenosis in Patients Undergoing Elective Surgery for Non-Metastatic Primary Rectal Cancer

Introduction: Benign anastomosis stenosis may develop in postoperative or long term period due to many reasons such as anastomosis leakage and anastomosis ischemia after colorectal surgery. While surgical treatment was commonly used in benign anastomosis stenosis in the past, surgery has left its place to more minimally invasive methods such as endoscopic treatments. There is no gold standard treatment method in the management of benign anastomosis strictures in the literature. In this study, we aimed to present our clinical experience in the treatment of benign anastomosis strictures in patients undergoing elective surgery for nonmetastatic primary rectal cancer. Material and Methods: One hundred fifty-six (156) patients who underwent resection and colorectal anastomosis between January 2013 and January 2018 were included in the study. 22 patients developed benign anastomotic stenosis has been determined and etiological factors and treatment modalities applied has been compared retrospectively. Results: In 22 patients, 9 patients were treated with digital or balloon dilatation, at least 2 sessions and up to 5 sessions. Four patients were treated with dilatation followed by stenting. The remaining 9 patients were taken to surgical treatment. Among whole patients with stenosis, it has been determined that 15 of them had neoadjuvant therapy history, 5 had anastomosis leakage and in 16 of them 28 mm circular stapler have been used. Discussion and Conclusion: Neoadjuvant treatment history, the presence of anastomosis leakage and the usage of 28 mm circular stapler have been detected to be the most important etiological factors in development of benign anastomotic stenosis. Endoscopic treatments should be tried primarily to treat benign anastomotic stenosis. High success rates can be achieved with endoscopic methods and patient quality of life can be improved. With this approach, the need for surgery will be reduced and possible postoperative complications can be prevented. Keywords: Rectal Neoplasms, Stenosis, Laparoscopy, Anastomostic stenosis

Non-operative Management of Benign Colorectal Anastomotic Stenosis in Patients Undergoing Elective Surgery for Non-Metastatic Primary Rectal Cancer

Objective: In this study, we aimed to present our clinical experience in the treatment of benign anastomosis strictures in patients undergoing elective surgery for nonmetastatic primary rectal cancer.&#x0D; Methods: One hundred fifty-six (156) patients who underwent resection and colorectal anastomosis between January 2013 and January 2018 were included in the study. 22 patients developed benign anastomotic stenosis has been determined and etiological factors and treatment modalities applied has been compared retrospectively.&#x0D; Results: In 22 patients, 9 patients were treated with digital or balloon dilatation, at least 2 sessions and up to 5 sessions. Four patients were treated with dilatation followed by stenting. The remaining 9 patients were taken to surgical treatment. Among whole patients with stenosis, it has been determined that 15 of them had neoadjuvant therapy history, 5 had anastomosis leakage and in 16 of them 28 mm circular stapler have been used.&#x0D; Conclusion: Neoadjuvant treatment history, the presence of anastomosis leakage and the usage of 28 mm circular stapler have been detected to be the most important etiological factors in development of benign anastomotic stenosis. Endoscopic treatments should be tried primarily to treat benign anastomotic stenosis. High success rates can be achieved with endoscopic methods and patient quality of life can be improved. With this approach, the need for surgery will be reduced and possible postoperative complications can be prevented.

A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty

Aim: Colonic anastomotic strictures are usually caused by staple use, anastomotic leakage, intestinal or suture line ischemia and radiotherapy. Endoscopic treatments should be the first choice. Resection of the stricture line and re-anastomosis form the basis of surgical treatment. Compared to endoscopic approaches, the morbidity rate of surgical treatments for strictures are higher. In patients with stricture and history of multiple pelvic surgeries who don’t allow endoscopic treatments, magnetic compression strictureplasty (MCS) may be a good choice for lower morbidity. Methods: The study population included patients with colorectal anastomotic stricture who had failed endoscopic treatments and for whom a tertiary resection and anastomosis was also considered as having high morbidity. Firstly, the MCS technique was planned by colonoscopic approach. It was aimed to place the magnet proximal to the stenotic colon with the colonoscope, which has a ring-shaped magnet attached at the tip, through the ileostomy entrance. This endoscopic approach failed. Then, laparotomy was performed. A 1-cm colotomy was performed from the proximal site of the stricture, and the magnet was left inside the intestine. Another magnet was placed distally to stricture from the anus. The two magnets were observed to compress the stricture by magnetic attraction, and the operation was terminated. Patient demographics, surgical history, MRI results, colonoscopic examination results were recorded. The follow-up conditions of the patients were noted.Results: MCS was performed on two male patients mean aged 70 (14.14) years. All patients had multiple abdominal surgeries in their surgical history. Colonoscopy showed fully obstructing anastomotic stricture in patients. The mean distance from the anal verge to the stricture in colonoscopic examination was 7±1.41 cm. Mean stricture length in MRI was 12±2.82 mm. In follow up, control rectosigmoidoscopies revealed that the magnets had fallen into the rectum lumen and the stricture line was fully patent for all patients.Conclusion: MCS might be preferred as a safe surgical technique with low morbidity in patients with previous multiple colorectal surgeries and a full obstructive stricture in the colorectal anastomosis line.

1524 Using Transillumination to Aid Dilation of a Severe Colorectal Anastomotic Stricture

INTRODUCTION: Colorectal anastomotic strictures are common complications of low anterior resection. Strictures in the lower rectum can be treated with direct digital dilation, but if in the upper rectum, endoscopic balloon dilation or electrocautery can be done. However, both procedures depend on the advancement of the wire through the circumferential scar/narrowed lumen. We present a unique case of endoscopic dilation of a severe anastomotic stricture using an innovative method. CASE DESCRIPTION/METHODS: A 44-year-old male with a history of rectal adenocarcinoma s/p low anterior resection with colorectal anastomosis and loop ileostomy formation presented to the GI clinic for constipation. Barium enema study revealed a stricture at the anastomotic site. A flexible sigmoidoscopy confirmed a severe anastomotic stricture, which could not be traversed nor lumen distal to the stricture visualized. And despite multiple attempts the guidewire could not pass through the stricture. Ten weeks after surgery, a pediatric colonoscope was passed through the ileostomy and advanced to the area of the stricture. Position was confirmed with fluoroscopy. At the same time an adult upper endoscope was inserted into the rectum and advanced to the stricture. The pediatric colonoscope was used to transilluminate the stricture and a needle was then used to puncture through the stricture under direct visualization. A guidewire was advanced through the newly created lumen retrograde and the tract was dilated up to 8 mm. A double pigtail plastic stent was inserted across the newly created tract. On repeat colonoscopy three weeks later, the double pigtail stent was removed and the stricture was dilated up to 15 mm. On subsequent colonoscopy, the stricture was dilated to 18 mm and the patients loop ileostomy reversed. The stricture was dilated again to 20 mm via Flexible sigmoidoscopy a month after the reversal after which constipation and bowel habits significantly improved. DISCUSSION: In patients who develop severe colorectal anastomotic strictures after a low anterior resection, endoscopic dilation can be challenging. In such patients ileoscopy and colonoscopy can be done simultaneously and using transillumination, position can be confirmed and a needle can be used to create a lumen through which a guide wire can be passed, allowing for serial dilation. Endoscopic dilation, should be tried and exhausted before considering surgical correction of a stricture, which can be difficult and increase morbidity.

Upfront lumen-apposing metal stenting for a high-grade colorectal anastomotic stricture.

Upfront lumen-apposing metal stenting for a high-grade colorectal anastomotic stricture.

Retrospective multicenter study of post-operative stenosis after stapled colorectal anastomosis.

Anastomotic stenosis after colorectal surgery is usually considered low-rate complication and often is under-reported in most studies. Few data are available on management strategies. The aim of the study was to assess the prevalence of stenosis after stapled colorectal anastomosis, performed either in elective or emergent setting, for benign or malignant disease, and to evaluate treatment profiles. This retrospective study was a survey conducted in a large Italian North-Eastern area including three regions (Triveneto), over a 12-month period (January-December 2015). Patients' characteristics and surgical technique details were recorded, along with data on the prevalence of stenosis and its treatment. Patients with mid or low rectal resection and/or neoadjuvant chemo-radio therapy and/or diverting stoma were excluded. The study was promoted by the Italian Association of Hospital Surgeons (ACOI) and the Society of Surgeons of the Triveneto Region. Twenty-eight surgical units were enrolled in the survey, accounting for over 1400 patients studied. Fifty percent of the units performed laparoscopically > 70% of the colorectal resections and 7.5% of the procedures were emergent. Less than 60% of the units planned regular endoscopic follow-up after colorectal resection. Anastomotic stricture was recorded in 2% of the patients; 88% of the stenoses were diagnosed within 6months from surgery. Only one anastomotic stricture required re-do surgery. The CANSAS study confirms that colorectal anastomotic stenosis is low-rate-but still present-complication. Treatment strategies vary according to surgeons' and endoscopists' preferences. Commonly endoscopic dilatation is preferred, but re-do surgery is required in some cases.

Treatment of anastomotic tubular stricture after anterior resection of rectal cancer

To investigate the treatment of colorectal anastomotic tubular stricture after anterior resection of rectal cancer. A retrospective study on 23 cases of anastomotic tubular stricture after anterior resection of rectal cancer from 2008 to 2017 at the Division of Colorectal Surgery, Department of General Surgery of Peking Union Medical College Hospital was performed. The general conditions of the patients, surgical procedures of rectal cancer, perioperative treatment, specific conditions of anastomotic stricture, treatment methods and outcomes were summarized and analyzed. Anastomotic tubular stricture was defined as follows: (1) The length of scar stenosis was >1 cm with thickening anastomotic intestinal wall and a 12 mm diameter colonoscopy could not pass through the anastomosis; (2) Patients were often accompanied by left abdominal pain when exhaust and defecation, increased frequency of defecation, fecal thinning and difficulty in defecation; (3) Anastomotic stricture was indicated by anal examination, colonoscopy, transanal proctography, and rectal MRI. Among 2035 patients undergoing anterior resection of rectal cancer from 2008 to 2017, 23 patients (1.1%) had anastomotic tubular stricture after operation, including 20 males and 3 females with age of 36 to 78 (58.3±10.2) years old. The anastomotic distance from the anal verge was less than 6 cm in 7 cases, 6 to 10 cm in 12 cases, and more than 10 cm in 4 cases. Twelve patients received radiotherapy, among whom 6 patients received neoadjuvant chemoradiation before surgery, and 6 patients received postoperative radiotherapy and chemotherapy. The initial treatment after anastomotic stricture: 9 cases (39.1%) underwent balloon dilation; 1 case(4.3%) underwent stenting; 1 case (4.3%) underwent transanal endoscopic microsurgery (TEM); 7 cases (30.5%) underwent permanent stoma and 5 patients (21.7%) underwent digestive tract reconstruction. Of the 12 patients receiving radiotherapy, 4 cases initially failed to undergo balloon dilatation; 1 case initially received a bare stent to relieve obstruction due to intestinal obstruction, but had re-stricture 1 month after stent removal, then was followed by permanent stoma surgery; 7 cases underwent resection of stenosis and permanent stoma, because the remaining intestine was too short for anastomosis. Of the 11 patients without radiotherapy, 5 patients were treated with balloon dilatation to relieve stenosis; 1 patient was initially treated with TEM, while posterior urethra was injured intraoperatively, and the urinary fistula finally healed with indwelling catheter; 5 patients underwent resection of the anastomotic stenosis, and no stenosis occurred after reconstruction of digestive tract, but 1 patient suffered from intraoperative presacral bleeding. Balloon dilatation is considered an effective treatment of anastomotic tubular stricture following anterior resection of rectal cancer, but with the risk of re-stenosis. Stricture resection and digestive tract reconstruction can be a radical way to improve stricture but with high risk of complications.