The Treatment Efficacy for Patients Undergoing Combined Transanal‐Transabdominal Endoscopic Resection of Rectal Anastomosis Stenosis

BACKGROUND: Combined transanal and transabdominal resection for anastomotic stenosis may provide an opportunity to restore bowel continuity in patients with colorectal anastomotic stenosis. This study aimed to evaluate the therapeutic efficacy of combined transanal-transabdominal resection in patients with rectal anastomotic stenosis. METHODS: We retrospectively analyzed a consecutive cohort of patients who underwent combined transanal-transabdominal endoscopic resection for rectal anastomotic stenosis between August 2019 and March 2023. Data on intraoperative variables, mortality, postoperative complications, and stoma closure were collected. Functional outcomes were evaluated using the Low Anterior Resection Syndrome (LARS) score and the Wexner incontinence score. RESULTS: A total of 54 patients, including 46 men and 8 women, met the inclusion criteria. In all patients, anastomotic stenosis developed secondary to either anastomotic leakage or preoperative radiotherapy. The median length of hospital stay was 15 days (11-24 days). No postoperative mortality occurred, and the overall morbidity rate was 15%. During a median follow-up of 48 months, stoma closure was achieved in 49 patients after a median interval of 3.8 months (2.5-11 months). At the end of follow-up, stoma closure had failed in 2 patients because of poor anastomotic functional outcomes, and 3 patients developed recurrent anastomotic stenosis. Among the 49 patients available for functional assessment, 35 (71.4%) reported no or minor LARS. The median Wexner incontinence score was 8 (0-18), and 13 patients had a score of 0. Erectile function was evaluated in 28 male patients, of whom 18 reported normal postoperative erectile function. CONCLUSIONS: Combined transanal-transabdominal endoscopic resection appears to be an effective treatment for rectal anastomotic stenosis, with a high rate of stoma closure, low morbidity, and acceptable long-term functional outcomes. CLINICAL TRIAL REGISTRATION NUMBER: NCT06036862.