Anoplasty for severe postsurgical anal stenosis: comparative randomized study

ABSTRACT

Cicatricial stenosis of the anal canal is a serious and disabling complication of anal surgery, which may be extremely difficult to manage. This comparative randomized study was performed to evaluate the efficacy, complication rate and recurrence of anal stenosis after Y-V anoplasty, diamond - shaped pedicle flap or house advancement pedicle flap and may be their indications in postoperative anal stenosis. In this study we reported 27 patients with severe anal stenosis. Eight of these patients underwent a Y-V anoplasty while nine had a diamond flap anoplasty and ten of these patients underwent house advancement flap anoplasty. All patients had bilateral anoplasty with or without partial internal sphincterotomy according to the presence or absence of an associated functional stenosis. All patients were seen 4 weeks, 6 months, one year and then annually after surgery. In the patients who underwent Y-V anoplasty, morbidity was in the form of haematoma and wound dehiscence in one patient and an ischemic contracture of the leading edge of the flap in other four patients. At 4 weeks follow up, all patients showed complete healing of wounds and most of them reported satisfactory results. Subjectively, one of the patients with house advancement pedicle flap complained of mild constipation, while, two patients with diamond pedicle flaps and 4 patients with Y-V anoplasty complained of moderate constipation. Six months postoperatively, neither further complications nor incontinence was observed. Furthermore, anorectal manometric studies revealed within normal resting and squeezing pressures for all patients. At one-year follow-up, all patients who underwent house advancement flap had complete remission of the symptoms. Among the 9 patients who underwent diamond pedicle flap, 7 judged their clinical results satisfactory while 2 patients had restenosis. OF the 8 patients who underwent YúV anoplasty, 4 patients had restenosis after one year. Although our cohort of patients is not huge, and randomized studies comparing the results of many different operative procedures used to correct anal stenosis are lacking in the literature, we can conclude that house advancement flap is a simple and safe method to correct postoperative anal stenosis with good long term results: