Modified wide base diamond flap anoplasty and anorectal manometric study and their impact on the outcome of management of cictatricial anal stenosis

ABSTRACT

Twenty patients were included in this study [17 men and 3 women with a mean age of 37.2 years]. Severe anal stenosis [AS] was found in 17 patients and moderate AS in 3 patients. Low AS was present in 4 cases, mid AS in 5 cases and diffuse AS in 11 patients. Hemorrhoidectomy was the cause of AS in 65% of the patients. The preoperative manometric study revealed hypertonia of the internal anal sphincter in 18 patients [16 with severe and 2 with moderate AS] and hidden posterior external sphincteric injury in one patient having pelvic colostomy. Diamond flap anoplasty with wide base was done bilaterally in patients with severe AS and unilaterally in those with moderate AS. Lateral partial internal sphincterotomy was done in all patients with preoperative hypertonia. Closed suction drainage of the dead subcutaneous space at the donor site was done only in 15 patients. In patients with sphincteric defect, posterior overlap repair was done one month after anoplasty. The study concluded that anoplasty using diamond flap with wide base technique is a safe method to correct cicatricial AS with good long-term results. Anorectal manometric study plays a role in the selection of patients for lateral partial internal sphincterotomy, detection of hidden external sphincteric injury and postoperative follow up of patients