Importance of the diameter of the mechanical suture in rectal surgery in relation to benign anastomotic stenosis. Cross-sectional observational study

PMCID: PMC12176904

PMID: 40533680

DOI: 10.1007/s10151-025-03157-9

Journal: Techniques in coloproctology

Publication Date: 2025-6-18

Authors: Llorach-Perucho N, Cayetano-Paniagua L, Serra-Aracil X

Key Points

• Postoperative rectal anastomotic stenosis rates range from 2-30%, with surgeons recognizing current rates as clinically significant
• 86.1% survey response rate, with 94.3% of surgeons acknowledging BAS rates as "too high"
• Increased awareness and adoption of larger mechanical sutures (>31 mm) and dilation techniques could potentially reduce anastomotic stenosis complications

Summary

This observational cross-sectional survey of 87 Spanish colorectal surgeons reveals significant knowledge gaps regarding benign anastomotic stenosis (BAS) in rectal surgery. Despite widespread recognition that BAS rates are problematically high (94.3% of respondents), less than half of surgeons (44.8%) were aware of their specific institutional BAS rates, and surgical approach to preventing stenosis remains largely subjective.

The study highlights critical variations in mechanical suture selection, with most surgeons using 28-29 mm (49.4%) or 31 mm (44.8%) sutures. Notably, 72.4% were unaware of dilation mechanisms to prevent postoperative stenosis, suggesting a substantial opportunity for clinical practice improvement. The majority of surgeons expressed interest in larger anastomotic diameters and potential dilation devices as strategies to mitigate stenosis risk.