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In left colon and rectal surgery, reconnecting the bowel after a resection can lead to complications. Some occur early, such as bleeding or anastomotic dehiscence, while others appear later, such as benign anastomotic stricture, which is a narrowing of the bowel at the operated site.

The reported frequency of this stricture is highly variable (between 2% and 30% of the times), partly because there are few studies and no clear, universally accepted definition. It is known to be more common after rectal surgery, which accounts for approximately 70% of cases. Other factors that increase the risk include male sex, obesity, smoking, diabetes, preoperative treatment, and the type and diameter of the anastomosis performed. In particular, some studies have suggested that the use of larger-diameter circular staplers may reduce the risk of stricture.

In a recent study conducted by our group, focused on low anterior resection of the rectum, stricture was found to be a relatively common problem, occurring in 16.3% of patients. In addition, the use of larger-diameter circular staplers (31–33 mm) was associated with fewer cases of narrowing.

As it was unknown to what extent surgeons were aware of this problem and its relationship with stapler diameter, we designed a survey aimed at colorectal surgeons across Spain (49 hospitals in total) that eighty-seven professionals responded (86.1% of those surveyed). Fewer than half were aware of the true rate of stricture after this type of surgery and, although nearly half considered the 16.3% rate to be similar to their own experience, the vast majority felt that this figure was excessively high.

Most surgeons choose the stapler size subjectively and few are familiar with or use specific measures to prevent stricture. However, after learning about the study findings, many expressed willingness to use larger-diameter staplers or intraoperative dilation systems, provided they were available and reasonably priced.

Although the study has the inherent limitations of survey-based research, it provides novel information. In conclusion, it highlights the limited awareness of the frequency of anastomotic stricture, its relationship with anastomotic diameter and surgeon’s interest in finding solutions that allow the creation of larger-calibre anastomoses and reduce this complication.