Role of Covering Ileostomy in Causation of Anastomotic Stricture in Low Anterior Resection for Rectal Carcinoma | ||
| Ain Shams Journal of Surgery | ||
| Volume 18, Issue 4, October 2025, Pages 333-337 PDF (278 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/asjs.2025.409466.1223 | ||
| Authors | ||
| Ahmed Mohamed Amer1; Mina F. A. Fouad1; Ahmed Abdalbary Ali1; Sharif Ahmed Abdalkarim1; Dalia Abdelfatah Mohamed2; Mona M Mamdouh2; Hussam Mohamed Farid* 1 | ||
| 1Surgical Oncology, GIT Surgical Oncology Unit, National Cancer Institute, Cairo University, Cairo, Egypt | ||
| 2Cancer Epidemiology and Biostatistics Department, Department of Pathology National Cancer Institute, Cairo University, Cairo, Egypt | ||
| Abstract | ||
| Introduction: Anastomotic stricture is a known complication after low anterior resection (LAR) for rectal cancer, with reported incidence rates between 5% and 19%. It is defined as a narrowing at the anastomotic site, potentially causing bowel obstruction and difficulty with defecation. Multiple factors influence stricture formation, including the level of anastomosis, surgical technique, preoperative chemoradiation, and use of a protective ileostomy. While diverting ileostomies are often used to mitigate the consequences of anastomotic leakage, their role in stricture development remains unclear. Aim of work: To compare the incidence of anastomotic stricture in patients undergoing LAR with and without covering ileostomy. Patients and methods: A retrospective cohort study was conducted on 200 patients who underwent LAR for rectal cancer at NCI -Cairo University from April 2022 to March 2024. Patients were divided into two equal groups (With and without ileostomy), and postoperative strictures were assessed using colonoscopy. Data were collected from medical records. Results: Stricture incidence was 15% in the ileostomy group and 10% in the non-ileostomy group (p = 0.067). No statistically significant associations were found with surgical approach, anastomotic technique, preoperative chemoradiation, or ileostomy reversal timing. However, stricture rate significantly correlated with lower anastomosis level (≤5 cm; p = 0.0119). Conclusion: Anastomotic strictures following LAR are multifactorial. While protective ileostomies do not significantly increase stricture risk, the level of anastomosis remains a key factor. Further prospective studies are needed to clarify causative mechanisms and optimize preventive strategies. | ||
| Keywords | ||
| Anastomotic stricture; anastomotic leakage; rectal cancer | ||
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