Late Anastomotic Complications (Stricture and Sinus)

Though their true incidence is difficult to measure, late anastomotic complications, comprising strictures and sinus tracts are estimated to occur in up to 30% of individuals requiring the construction of a colorectal anastomosis. Despite the cause of these anastomotic complications often being multifactorial, their etiology typically includes a combination of technical factors related to surgical technique as well as ischemia. Anastomotic strictures and sinus tracts present over a spectrum ranging from asymptomatic, incidental findings noted on endoscopy and radiographic studies to representing the cause of a surgical emergency in the form of a high-grade large bowel obstruction or intra-abdominal sepsis. Further, these complications often either delay the closure of a diverting stoma, or require the construction of one. Their management depends on the degree of symptoms attributed to them, the location of the anastomosis, the patient’s overall health status and degree of continence, and which endoscopic and surgical treatments are feasible given these other factors.