Transanal and Transabdominal Combined Endoscopic Redo Surgery for Benign Rectal Anastomotic Stenosis: Multicenter Outcomes and Factors Associated With Anastomosis-Related Failure.

Abstract

Benign rectal anastomotic stenosis after sphincter-preserving rectal cancer surgery remains a difficult reconstructive problem, particularly in a fibrotic pelvis. To evaluate outcomes and factors associated with anastomosis-related failure after transanal and transabdominal combined endoscopic redo surgery for benign rectal anastomotic stenosis. Retrospective multicenter observational cohort study. Three tertiary colorectal referral centers. Among 239 screened patients with anastomotic stenosis, 149 had benign rectal anastomotic stenosis after rectal cancer surgery and were included in the analysis. Anatomical success, restoration of bowel continuity, postoperative morbidity, and factors associated with anastomosis-related failure. The cohort included 149 patients, of whom 127 were men (85.2%). Mean age was 58.7 ± 9.9 years, and the mean interval from index surgery to redo surgery was 23.3 ± 28.9 months. Median follow-up was 27 months (IQR, 12-52). Anatomical success was achieved in 134 patients (89.9%), and bowel continuity was restored in 122 patients (81.9%). Anastomosis-related failure occurred in 15 patients (10.1%). In exploratory multivariable Firth penalized logistic regression, a preexisting chronic anastomotic defect was associated with anastomosis-related failure (adjusted OR, 3.249; 95% CI, 1.083-11.404; p = 0.035). Postoperative morbidity occurred in 34 patients (22.8%): Clavien-Dindo Grade I to II and grade III complications occurred in 17 patients each (11.4% each). No grade IV complications or 90-day deaths occurred. The retrospective design, potential selection bias, small number of failure events, and heterogeneity in surgical techniques and perioperative management across centers may limit generalizability. Transanal and transabdominal combined endoscopic redo surgery was associated with high rates of anatomical success and restoration of bowel continuity, with acceptable morbidity. A preexisting chronic anastomotic defect was associated with anastomosis-related failure and should be considered during patient selection and counseling. See Video Abstract.