# Safety and utility of long-acting steroid injection for management of post-operative stricture... — GCMD Library

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.

Type: video · 1 min · posted 2026-06-09
Canonical: https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169

## Chapters
- [0:00](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=0) Introduction and Study Design
- [0:38](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=38) Study Results
- [1:06](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=66) Clinical Implications

## Statements
- "The study was published in 2026 in the Journal of Pediatric Surgery" — Megan Reed Evaurri (clinical) [0:15](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=15)
- "The study examined institutional experience from 2018 to 2024" — Megan Reed Evaurri (clinical) [0:28](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=28)
- "50 patients developed post-operative anastomotic stricture: 30 with anorectal malformations and 20 with Hirschsprung disease" — Megan Reed Evaurri (epidemiological) [0:40](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=40)
- "70% of patients with anorectal malformations achieved stricture resolution with TAC injections" — Megan Reed Evaurri (clinical) [0:46](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=46)
- "85% of patients with Hirschsprung disease achieved stricture resolution with TAC injections" — Megan Reed Evaurri (clinical) [0:50](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=50)
- "The median number of TAC injections needed to achieve stricture resolution was 1 in both groups" — Megan Reed Evaurri (clinical) [0:55](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=55)
- "30% of anorectal malformation patients required surgery despite TAC injections" — Megan Reed Evaurri (clinical) [1:00](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=60)
- "10% of Hirschsprung disease patients required surgery despite TAC injections" — Megan Reed Evaurri (clinical) [1:00](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=60)
- "There were no intraoperative complications from TAC injections" — Megan Reed Evaurri (clinical) [1:06](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=66)
- "The 30-day complication rate was 2.2%" — Megan Reed Evaurri (clinical) [1:06](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=66)
- "TAC injections may be a safe, minimally invasive adjunct to traditional dilations with promising rates of stricture resolution and low short-term morbidity" — Megan Reed Evaurri (opinion) [1:14](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=74)
- "This is a retrospective single center study" — Megan Reed Evaurri (clinical) [1:27](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=87)
- "TAC injections may be a useful treatment option before moving on to another operation" — Megan Reed Evaurri (opinion) [1:27](https://library.globalcastmd.com/watch/safety-and-utility-of-long-acting-steroid-injection-for-management-of-post-operative-stricture-12169?t=87)

## Transcript
Do we have a safe way to reduce repeat procedures for patients with post-operative stricture after surgery for an anorectal malformation or Hirschprung disease? My name is Megan Reed Evaurri. I'm with the Center for Colorectal and Pelvic Reconstruction at Nationwide Children's Hospital, and this is an article you should know about. In 2026, we published a retrospective study in the Journal of Pediatric Surgery looking at the use of triamcinolone acetonide injections or TAC after dilation for postoperative. Systematic stricture for patients with anorectal malformations and Hirschprung disease. We studied our institution's experience in this procedure from 2018 to 2024 and asked whether adding tac to dilations was safe and whether it helped achieve stricture resolution. So, what did we find? We looked at 50 patients who developed post-operative anastomotic stricture, 30 with interectum affirmations and 20 with Hirschprug disease. We found that 70% of patients with innerectum affirmation. And 85% of patients with Hirschprung disease achieved stricture resolution with TA injections. The median number of injections needed to achieve stricture resolution was just 1 in both groups. There were still some patients who required surgery, 30% in the inter rectum malformation group and 10% in the Hirschsprung disease group. However, there were no intraoperative complications from the TA injections and the 30-day complication rate was 2.2%. So what's the takeaway? For patients with post-operative strictures who have anal rectum malformations or Hirschpring disease, TA injections may be a safe, minimally invasive adjunct to traditional dilations with promising rates of stricture resolution and low short-term morbidity. This is a retrospective single center study, but it suggests that these injections may be a useful treatment option before moving on to doing another operation. So, would this change the way that you manage post-operative recurrent anastomotic strictures at your institution?

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Not medical advice · citation policy: https://library.globalcastmd.com/ai