Pathophysiology of anastomotic stricture following rectal anastomosis: Insights into mechanisms, risk factors, and preventive strategies.

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.