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

Background: Postoperative benign anastomotic rectal stenosis (BAS) has a significant incidence rate (2-30%). Recently, it has been shown that its incidence decreases with a larger anastomotic diameter (≥ 31 mm). The level of awareness of this data and the interest in creating an intraoperative anastomotic dilation system remain unknown. The aim of the study is to evaluate, using a survey sent to Spanish colorectal surgeons, the knowledge of postoperative strictures in rectal surgery as well as the use of methods to prevent them.

Methods: An observational cross-sectional study was conducted using a survey sent to 101 colorectal surgeons from 49 colorectal surgery units in Spanish hospitals in June 2024.

Results: Eighty-seven responses were obtained (86.1%); 39 (44.8%) were aware of their BAS rate, 41 (47.1%) recognized it as similar to the rate reported by our group (16.3%), and 82 (94.3%) considered this rate too high. Regarding mechanical sutures, none used 25-mm sutures, 43/87 (49.4%) used 28-29-mm sutures, 39/87 (44.8%) used 31-mm sutures, and only 5/87 (5.7%) used 33-mm sutures; 72.4% (63/87) were unaware of the existence of dilation mechanisms, while 15 (17.2%) knew about or used some type of device. In an ideal dilation situation, mechanical dilation (60%) predominated over pneumatic, although the same number of surgeons would choose to use dilators (21/87) as would opt not to use them (22/87). Forty-three of 87 (43.9%) would tend to use larger anastomotic diameters (31 mm).

Conclusions: There is a significant lack of knowledge about the incidence of BAS and its relationship with the anastomotic diameter. Increased awareness of these issues is needed, aiming to use the widest possible mechanical sutures (> 31 mm) and considering the need for dilation devices to reduce the incidence of BAS.