대한대장항문학회

Introduction: Stapled anastomosis in the rectal cancer surgery has been already as a<br>safe technique, maintaing secure suture and saving times compared to handsewn<br>anastomosis. With the advancement of stapling device, the incidence of anastomotic<br>leakage has decreased significantly. However, development of anastomotic stricture has<br>become a major postoperative complication. Purpose: An analysis of the clinical features<br>and the predisposing factors of anastomotic stricture was made to identify its<br>pathogenesis and to determine adequate procedure. Methods: We analyzed 49 patients<br>(8.1%) with the rectal stricture among 608 patients, undergone stapled anastomosis for<br>the rectal cancer surgery at Asan Medical Center from jan 1993 to Dec 1998. Rectal<br>stricture was defined when index finger or colonoscope could not pass the anastomotic<br>site (high grade), or could pass with difficulty (low grade). Result: Underlying general<br>disease, e.g.,DM, hypertension and cardiovascular disease was associated more frequently<br>in patients with anastomotic stricture (20.4%) than patients without (10.8%)(p<0.05). The<br>rate of postoperative major complications in patients with stricture was 22.4%, while<br>that of anastomotic leakage was 6.1%. Development of anastomotic stricture was not<br>associated with operative methods, age, anastomosis level, and postoperative<br>radiotherapy. In patients with stricture, 34 patients (69.4%) were asymptomatic, and 15<br>patients were symptomatic. In treating symptomatic rectal stricture, only five patients<br>performed dilations manually or by the Hegar dilator. Conclusions: Rectal stricture after<br>stapled anastomosis might be associated with underlying disease, and correlated with<br>prolonged sanguinous drainage and ileus. Meticulous management of underlying disease<br>and complete hemostasis during operation appear to be important to reduce the rate<br>rectal stricture.<br>