Endoscopic laser stricturotomy and balloon dilatation for benign colorectal strictures

Abstract

BACKGROUND: A fibrous stricture may develop at the site of a colorectal anastomosis or as a complication following abdominal aortic surgery. A major resection may be necessary if the stricture cannot be released. The authors' experience with endoscopic stricturotomy using neodymium:yttrium-aluminium-garnet laser, together with balloon dilatation, as a conservative method of treating such strictures, is reported here. METHODS: The case notes of all patients referred for laser treatment of benign distal large bowel strictures at Concord Hospital were reviewed. RESULTS: Ten patients had endoscopic laser treatment combined with endoscopic balloon dilatation between October 1991 and July 1999. An anastomotic stricture had developed in eight patients and two patients had a fibrous stricture of the upper rectum after abdominal aortic aneurysm surgery. Nine of the 10 patients had their stricture treated successfully without complication or recurrence (median follow up 82 months; range: 14-104 months). The remaining patient re-presented with a large bowel obstruction at the site of his stricture 6 years following initial treatment. CONCLUSION: A protocol combining laser stricturotomy with balloon dilatation appears to be a safe and effective treatment of such strictures.