Role of Covering Ileostomy in Causation of Anastomotic Stricture in Low Anterior Resection for Rectal Carcinoma

Amer, Ahmed Mohamed; Fouad, Mina F. A.; Ali, Ahmed Abdalbary; Abdalkarim, Sharif Ahmed; Mohamed, Dalia Abdelfatah; Mamdouh, Mona M; Farid, Hussam Mohamed

doi:10.21608/asjs.2025.409466.1223

Role of Covering Ileostomy in Causation of Anastomotic Stricture in Low Anterior Resection for Rectal Carcinoma

Document Type : Original Article

Authors

¹ Surgical Oncology, GIT Surgical Oncology Unit, National Cancer Institute, Cairo University, Cairo, Egypt

² Cancer Epidemiology and Biostatistics Department, Department of Pathology National Cancer Institute, Cairo University, Cairo, Egypt

10.21608/asjs.2025.409466.1223

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.

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