Safety and utility of long-acting steroid injection for management of post-operative stricture...

This video details a retrospective study from Nationwide Children's Hospital exploring the safety and efficacy of long-acting triamcinolone acetonide (TAC) injections combined with dilation for post-operative strictures. The study focuses on pediatric patients who underwent surgery for anorectal malformation or Hirschsprung disease, aiming to reduce the need for repeat surgical procedures. Findings indicate high rates of stricture resolution with low short-term morbidity. Megan A Read, Brenna Rachwal, Liese C C Pruitt, Andrew C Sager, Alessandra C Gasior, Ihab Halaweish, Richard J Wood Purpose: Anastomotic stricture leads to significant post-operative morbidity for patients with anorectal malformations (ARM) and Hirschsprung Disease (HSCR). The injection of the long-acting steroid triamcinolone acetonide (TAC) after stricture dilation has been shown to decrease stricture recurrence and interventions needed to achieve resolution but has yet to be studied in patients with ARM or HSCR. Methods: We performed a single-institution retrospective review of patients with ARM or HSCR who underwent TAC injection with dilation for anastomotic stricture. Clinical history, procedural details, and post-injection outcomes were assessed. Results: From 2018 to 2024, 50 patients, 30 with ARM and 20 with HSCR, underwent dilation of anastomotic stricture followed by TAC injection. Stricture resolution was observed in 21 patients (70.0 %) with ARM and 17 patients with HSCR (85.0 %) after dilation with TAC injection. The median number of injections to achieve resolution was 1 in both groups, with a maximum of 5 in both diagnosis groups. Nine patients (30.0 %) with ARM and 2 with HSCR (10.0 %) ultimately required surgery to achieve resolution. There were no significant differences in clinical characteristics between those who required surgery and those who did not within each diagnosis group. There were no intraoperative complications; 30-day complication rate was 2.2 %. Conclusions: Injection of TAC as an addition to dilation of post-operative stricture is a safe, minimally invasive approach to stricture management. The outcomes for our patients with ARM and HSCR are promising, and we plan for additional prospective study to further explore the benefits.