Ileoanal Anastomotic Stricture

Stenosis of the ileoanal anastomosis is the most common perineal complication after IPAA. The precise definition is unclear and contributes to the wide range of incidence reported in the literature. Narrowing, which requires at least one dilatation under anaesthesia, has been reported in 4-40% of cases [51, 52]. The main causative factors are pelvic sepsis with subsequent fibrosis and tension on the anastomosis leading to ischaemia. Patients most frequently present with symptoms of straining, increased number of bowel movements per day, watery stool, urgency of defecation, a feeling of incomplete evacuation and abdominal or anal pain. Rectal examination and contrast pouchography if needed confirm the diagnosis. Anastomotic strictures can be noted before or after ileostomy closure. Most strictures, especially those found during an outpatient clinic visit before ileosto-my closure, are annular and web like due to lateral adhesions across the anastomosis and can be treated successfully with a simple digital anal dilatation. Severe strictures usually require repeat dilatations. If a stricture persists in spite of repeated dilatations, surgery is required. Despite all salvage attempts, up to 15% of patients with severe anastomotic stricture will eventually come to pouch excision and permanent ileostomy [53].

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