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Anastomotic stricture is a benign condition in which scar tissue grows at the site of a surgical connection (anastomosis) between two hollow organs or tubular structures, causing narrowing of the lumen. Anastomotic stricture most commonly occurs after gastric bypass surgery, colorectal resection, oesophageal surgery, and bariatric operations, affecting 5–20% of patients who have undergone colorectal surgery.

This syndrome usually develops 3 to 12 months following surgery, but early strictures can occur within weeks. Risk factors: Use of circular staples instead of sutures; impaired blood flow to the point of anastomosis Scarring Anastomotic leaks Ischaemia Smoking Frequent use of aspirin or NSAIDs produces ulcers at the connection.

Symptom location varies. Patients after gastric bypass present with nausea, vomiting of undigested food, dysphagia, early satiety, and an extended feeling of fullness. Symptoms of colorectal strictures include constipation, watery diarrhoea, stomach pain, cramps and trouble passing stool.

Diagnosis is either an upper GI series with contrast dye or an endoscopy to visualise the constriction. The main treatment is endoscopic dilatation. This involves using a balloon to stretch the stricture back to normal size during an endoscopy. Most patients will need several dilation procedures. Proton pump inhibitors lower stomach acid and help healing. Severe or total closures may require transanal minimally invasive surgery (TAMIS) or reconstructive surgery. Prevention involves avoidance of NSAIDs, smoking cessation, and adherence to post-operative dietary recommendations.