Yavuz A, Pehlevan-Özel H, Tez M. Pathophysiology of anastomotic stricture following rectal anastomosis: Insights into mechanisms, risk factors, and preventive strategies. World J Gastrointest Pathophysiol 2025; 16(2): 107492 [DOI: 10.4291/wjgp.v16.i2.107492]
Corresponding Author of This Article
Mesut Tez, Professor, Department of Surgery, University of Health Sciences, Ankara City Hospital, No. 1 Bilkent Street, District of Universities, Ankara 06800, Türkiye. mesuttez@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pathophysiol. Jun 22, 2025; 16(2): 107492 Published online Jun 22, 2025. doi: 10.4291/wjgp.v16.i2.107492
Pathophysiology of anastomotic stricture following rectal anastomosis: Insights into mechanisms, risk factors, and preventive strategies
Ahmet Yavuz, Hikmet Pehlevan-Özel, Mesut Tez
Ahmet Yavuz, Hikmet Pehlevan-Özel, Department of Surgery, Ankara Bilkent City Hospital, Ankara 06800, Türkiye
Mesut Tez, Department of Surgery, University of Health Sciences, Ankara City Hospital, Ankara 06800, Türkiye
Author contributions: Yavuz A was responsible for conceptualization, methodology, data curation, writing – original draft preparation; Pehlevan-Özel H was responsible for investigation, formal analysis, visualization, writing – review & editing; Tez M was responsible for supervision, project administration, validation, writing – review & editing; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose. There are no financial, personal, or professional relationships that could be perceived to influence the work presented in this manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mesut Tez, Professor, Department of Surgery, University of Health Sciences, Ankara City Hospital, No. 1 Bilkent Street, District of Universities, Ankara 06800, Türkiye. mesuttez@yahoo.com
Received: March 25, 2025 Revised: March 28, 2025 Accepted: May 8, 2025 Published online: June 22, 2025 Processing time: 86 Days and 21.1 Hours
Abstract
Anastomotic stricture (AS) remains a significant complication following rectal anastomosis, with an incidence ranging from 5% to 30% depending on surgical technique, patient factors, and postoperative management. This review aims to elucidate the pathophysiology of AS, exploring the underlying mechanisms that contribute to its development, including ischemia, inflammation, fibrosis, and impaired healing. Key risk factors such as low anterior resection, preoperative radiotherapy, and anastomotic leakage are critically analyzed based on recent clinical and experimental evidence. The article synthesizes current insights into the molecular and cellular processes, such as excessive collagen deposition and myofibroblast activation, that drive stricture formation. Furthermore, preventive strategies, including optimized surgical techniques (e.g., tension-free anastomosis), enhanced perioperative care, and emerging therapeutic interventions (e.g., anti-fibrotic agents), are discussed with an emphasis on translating research into clinical practice. By integrating findings from preclinical studies, clinical trials, and meta-analyses, this review highlights gaps in current knowledge and proposes future directions for research, such as the role of personalized medicine and novel biomaterials in reducing AS incidence. This comprehensive analysis underscores the need for a multidisciplinary approach to mitigate this challenging postoperative complication.
Core Tip: Anastomotic stricture following rectal anastomosis is a multifactorial complication driven by fibrosis, inflammation, anastomotic leakage, radiotherapy, and ischemia. This review highlights the pathophysiological mechanisms, including excessive collagen deposition and transforming growth factor-beta activation, and identifies key risk factors such as neoadjuvant radiotherapy and surgical technique. Preventive strategies, such as preserving blood supply and using standardized stapling techniques, are emphasized to improve patient outcomes and reduce stricture incidence.
