Background: Combined transanal- transabdominal resection of anastomotic stenosis has the potential to restore bowel continuity for patients with instead of suffered rectal tubular anastomotic stenosis. The objective of this study was to assess the long-term functional outcomes in patients who underwent combined transanal- transabdominal resection of rectal tubular anastomotic stenosis.
Methods: We retrospectively included a cohort of consecutive patients who underwent combined transanal-transabdominal endoscopic resection for rectal tubular anastomotic stenosis. This study encompassed the period from August 2019 to October 2022. We gathered data pertaining to intraoperative details, mortality, postoperative complications, and the rate of stoma closure. Functional outcomes were assessed using the low anterior resection syndrome (LARS) and Wexner incontinence questionnaires.
Results: A total of 35 patients, comprising 28 men and 7 women, met the inclusion criteria. All patients exhibited anastomotic stenosis resulting from anastomotic leakage or preoperative radiotherapy. The median duration of hospitalization was 14 (11-24) days. No instance of mortality was recorded. The morbidity rate was 14%. Stoma closure was performed in 32 patients after a mean delay of 3 (2.5-11) months. At the end of follow-up, two patients with failed stoma closure due to poor functional outcomes of anastomosis, while one patient experienced a recurrence of anastomotic stenosis. Among the 29 patients who were available for follow-up, 19 (65%) reported either no or minor LARS symptoms. The median Wexner incontinence score was 8 (0-19). Notably, 10 patients achieved a Wexner incontinence score of 0. Erectile function was assessed in 18 male patients, and 8 of them reported normal postoperative erectile function.
Conclusions: Combined transanal- transabdominal endoscopic resection is an effective approach for treating rectal tubular anastomotic stenosis, demonstrating a high stoma closure rate, low morbidity associated with complications, and favorable long-term functional outcomes.
