{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:45:13Z","timestamp":1789764313160,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T00:00:00Z","timestamp":1727827200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Anastomotic stricture occurs in up to 30% of colorectal resections; however, evidence on risk factors and preventive measures remains scarce. This study aimed to identify technical factors responsible for increasing the risk for colorectal and coloanal anastomotic strictures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a retrospective cohort study of patients with anastomotic stricture who underwent resection and\/or redo anastomosis between January 1, 2011 and August 1, 2021 in a tertiary referral centre. Patients with anastomotic stricture were compared with an equal number of randomly selected patients without anastomotic complications, who were operated on during the same time period. The main outcome measures were technical risk factors of anastomotic stricture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Each group included 50 patients who were similar for age, sex, American Society of Anesthesiologists score, distance of anastomosis to the dentate line and indication for surgery. Median follow\u2010up was significantly longer in the non\u2010stricture group (38.6\u2009months vs. 12.6\u2009months, <jats:italic>p<\/jats:italic>\u2009=\u20090.04). Splenic flexure mobilization [hazard ratio (HR)\u2009=\u20090.18 [2], 95% CI: 0.08\u20130.39, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001], high ligation of the inferior mesenteric artery (HR\u2009=\u20090.22, 95% CI: 0.09\u20130.5, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and high ligation of the inferior mesenteric vein (HR\u2009=\u20090.21, 95% CI: 0.09\u20130.50, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) were associated with a\u00a0lower likelihood of anastomotic stricture. Conversely, use of a 25\u2010mm\u2010diameter circular stapler (HR\u2009=\u200922.69, 95% CI:\u20092.69\u2010191.10, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), clinically significant anastomotic leak (HR\u2009=\u20093.94, 95% CI: 2.04\u20137.64, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), firing the stapler more than once for rectal division (HR\u2009=\u200924.75, 95% CI:\u20096.85\u201389.38, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and diverting stoma (HR\u2009=\u20093.087, 95% CI: 1.736\u20135.491, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) were predictive of an anastomotic stricture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Failure to mobilize the splenic flexure and to perform high ligation of the inferior mesenteric vessels were associated with higher odds of anastomotic stricture. A small\u2010diameter circular stapler and multiple distal stapler firings were also associated with anastomotic stricture. These data support routine splenic flexure ligation and high ligation of the inferior mesenteric vessels as well as avoidance of both multiple \u00a0stapler firings for rectal transection and a 25\u2010mm circular stapler for anastomosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.17184","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T04:44:04Z","timestamp":1727930644000},"page":"1996-2002","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Technical risk factors for benign anastomotic strictures in colorectal and\/or coloanal anastomosis: A retrospective case\u2013control study"],"prefix":"10.1111","volume":"26","author":[{"given":"Zoe","family":"Garoufalia","sequence":"first","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida  Weston Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7820-2903","authenticated-orcid":false,"given":"Sarinya","family":"Meknarit","sequence":"additional","affiliation":[{"name":"Charles E. Schmidt College of Medicine, Florida Atlantic University  Boca Raton Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7854-5244","authenticated-orcid":false,"given":"Sameh Hany","family":"Emile","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida  Weston Florida USA"},{"name":"Colorectal Surgery Unit, General Surgery Department Mansoura University Hospitals  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Gefen","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida  Weston Florida USA"},{"name":"Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Horesh","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida  Weston Florida USA"},{"name":"Department of Surgery and Transplantations Sheba Medical Center  Ramat Gan Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peige","family":"Zhou","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida  Weston Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Rogers","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida  Weston Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"DaSilva","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida  Weston Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8046-5753","authenticated-orcid":false,"given":"Steven D.","family":"Wexner","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida  Weston Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,2]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-002-8926-3"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-012-0929-z"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2021.05.016"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2012.244"},{"key":"e_1_2_12_7_1","first-page":"277","article-title":"Dilation of benign strictures following low anterior resection using Savary\u2010Gilliard bougies. 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