Dilation of benign strictures following low anterior resection using Savary-Gilliard bougies.

BACKGROUND AND STUDY AIMS: Benign anastomotic strictures occur in up to 22% of patients after colorectal resections. Initially, treatment for these strictures was surgical, but nowadays endoscopic dilation techniques are preferred. This study was conducted to assess the efficacy of dilation using SavaryGilliard bougies.

PATIENTS AND

METHODS

From 1987 to 1994, 256 consecutive patients underwent low anterior resection (LAR). Twenty-one patients (8.2%) developed a stricture of the colorectal anastomosis. Follow-up data were available for 18 of these patients. The patients were treated using endoscopic Savary dilation, with bougies of increasing diameters (10-19 mm). The mean follow-up period was 19 months (1-60 months).

RESULTS

Stricture symptoms presented after a mean period of 7.7 months after LAR. In three of the 18 patients, the stenosis was caused by local recurrence, and these patients were excluded from further evaluation. Normal defecation was restored in 10 of the remaining 15 patients, and symptoms disappeared. In five patients, there was only partial improvement, but only three of them required another type of treatment. Of four patients who received radiotherapy and developed a strictured anastomosis, two had successful dilations. A normal defecation pattern was never regained if more than three dilations were necessary. No complications caused by Savary dilation were observed.

CONCLUSIONS

In this study population, Savary dilation appeared to be a safe and effective treatment for benign anastomotic strictures after LAR. All successfully treated patients (ten of 15) required no more than three dilations. Two other patients had partial success. Only three patients required another form of treatment (two endoscopic, one surgical).