Annals of Coloproctology

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Original Article

Anorectal benign disease

Efficacy and safety of low-dose triamcinolone acetonide injections in reducing stricture at stapled hemorrhoidopexy sites: Sangmin Youn, Dowon Kim, Jieun Kim, Jung-A Yun, Hyunjung Park; Ann Coloproctol. 2026;42(2):247-255. Published online April 15, 2026; DOI: https://doi.org/10.3393/ac.2025.01088.0155

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Graphical Abstract Abstract PDF Supplementary Material: Purpose
Stapled hemorrhoidopexy (SH) is commonly used to treat severe internal hemorrhoids and rectal mucosal prolapse associated with prolapsing hemorrhoids. A common complication of SH is SH site stricture (SHsS), which negatively affects quality of life. This study evaluated the efficacy and safety of low-dose triamcinolone acetonide (TA) injection at the SH site for the prevention of SHsS.
Methods
Between 2020 and 2023, 1,023 patients underwent SH, with an average of 3.3 external hemorrhoids being excised per patient. The fluid mixture contained 40 mg of TA per 100 mL (0.4 mg/mL), with 5 mL (2 mg of TA) injected at the SH site and 2–3 mL (1.2 mg of TA) at each excisional hemorrhoidectomy site. The TA group (n=554; propensity score matching [PSM]-adjusted, n=375) received TA injections, whereas the non-TA group (n=469; after PSM, n=375) received conventional epinephrine injections. PSM was adjusted for age, sex, concurrent surgeries, botulinum toxin injection, and excisional hemorrhoidectomy frequency. Logistic regression models were used to analyze SHsS and reoperation rates.
Results
SHsS rate was significantly lower in the TA group (2.9%) than in the non-TA group (16.0%). Furthermore, the reoperation rate was lower in the TA group (5.9%) than in the non-TA group (14.4%).
Conclusion
Low-dose TA injections effectively prevent SHsS and reduce reoperation rates without increasing the risk of infection, providing a safe, cost-effective approach to improving surgical outcomes.

Case Reports

Malignant disease

Treatment of a Total Obstructive Anastomosis Stricture Using a Transanal Laparoscopic Approach and Intraoperative Colonoscopic Balloon Dilatation: Jae Young Kwak, Kwan Mo Yang, Hyun Il Seo; Ann Coloproctol. 2020;36(5):353-356. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.02.27

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1 Citations

Abstract PDF

An anastomosis stricture with a total obstruction is rare and treatment options are variable. We describe our experience with a combination of a single port transanal laparoscopic approach and intraoperative colonoscopic balloon dilatation. The patient was a 48-year-old man with rectal cancer. A laparoscopic single port lower anterior resection and diverting ileostomy were performed followed by a colon study and ileostomy takedown. The colon study and sigmoidoscopy revealed total obstruction of the rectum at the anastomosis level. We employed a transanal approach using a single port to correct this. We located the anastomosis stricture site and generated a lumen using a dissector and electocautery method to insert the balloon device. Colonoscopic balloon dilatation was subsequently successful. The patient was discharged with no postoperative complications. A laparoscopic single port transanal approach with an intraoperative colonoscopic balloon dilatation is a viable alternative approach to treating an anastomosis stricture of the rectum.

Citations

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Successful Endoscopic Treatment of a Complete Ileorectal Anastomotic Stenosis
F Kreve, MHD P Ribeiro, A De lacerda clevelario, T Darcadia dos Reis, R Costa, C Garcia Montes, J Manara Martins, D Bonilha
Endoscopy.2026; 58(S 03): S977. CrossRef

Colon Stricture After Ischemia Following a Robot-Assisted Ultra-Low Anterior Resection With Coloanal Anastomosis: Dae Ro Lim, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Nam Kyu Kim; Ann Coloproctol. 2015;31(4):157-162. Published online August 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.4.157

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7 Web of Science
9 Citations

Abstract PDF

Four consecutive cases of a colonic stricture following a da Vinci robot-assisted ultra-low anterior resection (LAR) with coloanal anastomosis and diverting ileostomy for the treatment of rectal cancer are reported. The colonic strictures developed after early proximal colonic ischemia without anastomotic site leakage or disruption. All patients were treated with preoperative chemoradiation therapy. During the postoperative recovery period, patients developed colonic ischemia, presenting with a high, spiking fever, but without any symptoms of peritonitis. Patients were treated with conservative management (antibiotic therapy) and discharged after two weeks when in good condition. Several months after discharge, all four patients developed a long-segment colonic stricture from the anastomosis site to the distal colon. Management of the colon strictures, including the anastomotic site, involved colonic dilation with a Hegar dilator in an outpatient clinic for several months. The ileostomies in three patients could not be closed.

Citations

Citations to this article as recorded by

Laparoscopic Abdominoperineal Resection for Ischemic Colitis after Laparoscopic Partial Resection of the Descending Colon: Case Report
Mitsuki Yokota, Hidekazu Takahashi, Asako Mike, Kei Fukumori, Yuka Iwami, Juavijitjan Watsapol, Satoshi Ishikawa, Shohei Takaichi, Masakatsu Paku, Kazuya Iwamoto, Tomofumi Ohashi, Yujiro Nakahara, Kohei Murakami, Tadafumi Asaoka, Ichiro Takemasa, Takeshi
Surgical Case Reports.2026; 12(1): n/a. CrossRef
Pathophysiology of anastomotic stricture following rectal anastomosis: Insights into mechanisms, risk factors, and preventive strategies
Ahmet Yavuz, Hikmet Pehlevan-Özel, Mesut Tez
World Journal of Gastrointestinal Pathophysiology.2025;[Epub] CrossRef
Comment on “Risk Factors for Benign Anastomotic Stenosis After Esophagectomy for Cancer”
Rachana Mehta, Ranjana Sah
Annals of Surgical Oncology.2025; 32(12): 9306. CrossRef
Magnetic resonance imaging in the diagnosis of necrosis of a pulled-through colon segment after abdomino-anal resection of the rectum for cancer
Sofiya A. Myalina, Ksenia I. Paziuk, Tatiana P. Berezovskaya, Alexey A. Nevolskikh, Aleksandr L. Potapov, Sergey A. Ivanov
Digital Diagnostics.2023; 4(1): 61. CrossRef
Prolonged ischemia of the ileum and colon after surgical mucosectomy explains contraction and failure of “mucus free” bladder augmentation
Dániel Urbán, Gabriella Varga, Dániel Érces, Mahmoud Marei Marei, Raimondo Cervellione, David Keene, Anju Goyal, Tamás Cserni
Journal of Pediatric Urology.2022; 18(4): 500.e1. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Surgical specimen extraction via a prophylactic ileostomy procedure: A minimally invasive technique for laparoscopic rectal cancer surgery
Peng Wang, Jian-Wei Liang, Hai-Tao Zhou, Zheng Wang, Zhi-Xiang Zhou
World Journal of Gastroenterology.2018; 24(1): 104. CrossRef
Risk factors including the presence of inflammation at the resection margins for colorectal anastomotic stenosis following surgery for diverticular disease
A. Bressan, L. Marini, M. Michelotto, A. C. Frigo, G. Da Dalt, S. Merigliano, L. Polese
Colorectal Disease.2018; 20(10): 923. CrossRef
Vascular anatomy of inferior mesenteric artery in laparoscopic radical resection with the preservation of left colic artery for rectal cancer
Ke-Xin Wang, Zhi-Qiang Cheng, Zhi Liu, Xiao-Yang Wang, Dong-Song Bi
World Journal of Gastroenterology.2018; 24(32): 3671. CrossRef

Rectal Perforation Caused by Anal Stricture After Hemorrhoid Treatment: Yong Joon Suh, Heon-Kyun Ha, Heung-Kwon Oh, Rumi Shin, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2013;29(1):28-30. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.28

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2 Citations

Abstract PDF

Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5℃. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation.

Citations

Citations to this article as recorded by

The Complications of Hemorrhoidectomy From Patients' Perspective: A Qualitative Study
Masoumeh Ebrahimi Tavani, Yegane Partovi, Tahmineh Poursaki, Farid Gharibi
Health Science Reports.2025;[Epub] CrossRef
Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis
Hendry Lie, Evelyn Franca Caesarini, Antonius Agung Purnama, Andry Irawan, Taufik Sudirman, Wifanto Saditya Jeo, Bernardus Parish Budiono, Erik Prabowo, M. Iqbal Rivai, Ryanto Karobuana Sitepu
Lasers in Medical Science.2022; 37(9): 3621. CrossRef

A New Technique Using Ultra-slim Endoscopy for High-Grade Crohn's Stricture: Ga Hee Kim, Kyung-Jo Kim, Gi Ae Kim, Jee Eun Yang, Hee Jung Park, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang; J Korean Soc Coloproctol. 2012;28(5):271-274. Published online October 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.5.271

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3 Citations

Abstract PDF

Crohn's disease (CD) is a chronic inflammatory bowel disease of unknown etiology. Most patients with CD will eventually develop a stricturing or penetrating complication. Colonoscopic findings may predict the clinical course in patients with CD. Moreover, since CD patients are at increased risk for developing dysplasia and colorectal cancer, surveillance colonoscopy is necessary for the detection of malignancies. We describe here a CD patient with a high-grade anorectal stricture who successfully underwent a total colon examination with an ultra-slim upper endoscope after an insertion failure with a standard colonoscope and gastroscope.

Citations

Citations to this article as recorded by

ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology
Michel Adamina, Roger Feakins, Marietta Iacucci, Antonino Spinelli, Rosanna Cannatelli, André D’Hoore, Ann Driessen, Konstantinos Katsanos, Aart Mookhoek, Pär Myrelid, Gianluca Pellino, Georgios Peros, Gian Eugenio Tontini, Monika Tripathi, Henit Yanai, M
Journal of Crohn's and Colitis.2021; 15(7): 1089. CrossRef
Super-slim endoscopy, in a patient with a Crohn’s ileocecal valve stricture, for assessment of mucosal healing
S. Pontone, C. Cicerone, F. M. Magliocca, P. Vernia
Techniques in Coloproctology.2016; 20(4): 259. CrossRef
Clinical impact of ultrathin colonoscopy for Crohn's disease patients with strictures
Kenichi Morimoto, Kenji Watanabe, Atsushi Noguchi, Takako Miyazaki, Yasuaki Nagami, Satoshi Sugimori, Noriko Kamata, Mitsue Sogawa, Tetsuya Tanigawa, Hirokazu Yamagami, Masatsugu Shiba, Kazunari Tominaga, Toshio Watanabe, Yasuhiro Fujiwara, Tetsuo Arakawa
Journal of Gastroenterology and Hepatology.2015; 30(S1): 66. CrossRef

Original Articles

Endoscopic Balloon Dilatation for Anastomotic Stricture Developed after Surgery for Colorectal Cancer.: Kim, Byung Nyun , Sohn, Dae Kyung , Hong, Chang Won , Han, Kyung Su , Choi, Dong Hyun , Park, Ji Won , Lim, Seok Byung , Choi, Hyo Seong , Jeong, Seung Yong; J Korean Soc Coloproctol. 2008;24(1):27-33.; DOI: https://doi.org/10.3393/jksc.2008.24.1.27

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Abstract PDF: PURPOSE
This study was to evaluate the safety and efficacy of endoscopic balloon dilatation for anastomotic strictures that developed after colorectal cancer (CRC) operations.
METHODS
Between Jan. 2001 and Dec. 2006, 18 patients (12 men, 6 women) who underwent endoscopic balloon dilatation for anastomotic strictures that developed after CRC operation at the Center for Colorectal Cancer, National Cancer Center, were enrolled, and their medical records were reviewed retrospectively. The median distance from the anal verge to the stricture was 10 cm (range, 3~40 cm). Dilatations were performed using through-the-scope balloons with diameters of 18 to 20 mm on inflation. RESULTS: The overall success rate of endoscopic balloon dilatation was 94.4% (17 patients). The mean number of treatment sessions per patient was 1.9 (range, 1~7). Of the 17 patients treated successfully, 11 patients (64.7%) required only one dilatation, 4 patients (23.2%) required 2 dilatations, and two patients (11.8%) required 7 dilatations. Failure of balloon dilatation occurred in one patient. No complications occurred. CONCLUSIONS: Endoscopic balloon dilatation of anastomotic strictures after a CRC operation is safe and efficient.

Analysis and Measures for Anal Stricture following a Hemorrhoidectomy.: Lim, Seok Won; J Korean Soc Coloproctol. 2006;22(5):293-297.

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Abstract PDF: PURPOSE
The most common cause of anal stricture following a hemorrhoidectomy is excision of too much hemorrhoidal tissue. However, the extent of excision of the hemorrhoid and other factors that can lead to an anal stricture are not yet well known. Thus, the author analyzed cases of anal stricture in order to find a method to prevent anal stricture.
METHODS
The author analyzed 14 patients who had anal stricture following a hemorrhoidectomy among 750 hemorrhoidectomy patients at Hang clinic from Jan. 2003 through Dec. 2003. The author analyzed the relation between the incidence of anal stricture and factors such as the number of hemorrhoids removed, the depth of the ligation, and the preoperative anal tension. The author also analyzed the treatment method for postoperative anal stricture.
RESULTS
1) The male-to-female ratio for these 14 cases was 3 : 11, and the most prevalent age group was the 4th decade, followed by the 5th decade. 2) The incidences of postoperative anal stricture for patients with one to six piles removed were 0%, 0.5%, 0.9%, 4.6%, 6.5%, and 14%, respectively. 3) In analysis of anal stricture according to the depth of ligation, the patient who had two removed hemorrhoids had two high ligations without low ligation (1 case). The patients who had three removed hemorrhoids had three high ligations without low ligation (2 cases). The patients who had four removed hemorrhoids had three high ligations with one low ligaton (3 cases) and four high ligations without low ligation (3 cases). The patients who had 5 removed hemorrhoids had three high ligations with two low ligations (2 cases) and four high ligations with one low ligation (1 case). The patients who had six removed hemorrhoids had three high ligations with three low ligations (2 cases). 4) There were 5 cases (7.6%) of anal stricture for high preoperative anal tension and 9 cases (1.3%) for low preoperative anal tension. 5) The treatment methods for postoperative anal stricture were bougination (10 cases), a sphincterotomy (2 cases), and a sliding skin graft (2 cases).
CONCLUSIONS
For the prevention of postoperative anal stricture, removal of three or fewer hemorrhoids seems ideal. Low ligation may be better than high ligation in preventing anal stricture, and the hemorrhoidectomy should be performed more cautiously in cases of high preoperative anal tension. In conclusion, the number, the width, and the length of the removed hemorrhoid, as well as the preoperative anal tension, should be considered to prevent postoperative anal stricture.

Anastomotic Stricture after Colorectal Stapled Anastomosis.: Hong, Hyoun Kee , Jeong, Choon Sik , Lee, Dong Hee , Kim, Hee Cheol , Yu, Chang Sik , Park, Sang Kyu , Kim, Sook Young , Kim, Jin Cheon; J Korean Soc Coloproctol. 2000;16(3):198-203.

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Abstract PDF: INTRODUCTION: Stapled anastomosis in the rectal cancer surgery has been already proven as a safe technique, maintaing secure suture and saving times compared to handsewn anastomosis. With the advancement of stapling device, the incidence of anastomotic leakage has decreased significantly. However, developement of anastomotic stricture has become a major postoperative complication. PURPOSE: An analysis of the clinical features and the predisposing factors of anastomotic stricture was made to identify its pathogenesis and to determine adequate procedure.
METHODS
We analyzed 49 patients (8.1%) with the rectal stricture among 608 patients, undergone stapled anastomosis for the rectal cancer surgery at Asan Medical Center from Jan 1993 to Dec 1998. Rectal stricture was defined when index finger or colonoscope could not pass the anastomotic site (high grade), or could pass with difficulty(low grade). RESULTS: Underlying general diseases, e.g., DM, hypertension and cardiovascular disease was associated more frequently in patients with anastomotic stricture (20.4%) than patients without (10.8%) (P<0.05). The rate of postoperative major complications in patients with stricture was 22.4%, while that of anastomotic leakage was 6.1%. Development of anastomotic stricture was not associated with operative methods, age, anastomosis level, and postoperative radiotherapy. In patients with stricture, 34 patients (69.4%) were asymptomatic, and 15 patients were symptomatic. In treating symptomatic rectal stricture, only five patients performed dilation manually or by the Hegar dilator.
CONCLUSIONS
Rectal stricture after stapled anastomosis might be associated with underlying diseases, and correlated with prolonged sanguinous drainage and ileus. Meticulous management of underlying disease and complete hemostasis during operation appear to be important to reduce the rate of rectal stricture.

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