Use of "house" advancement flap in anorectal diseases.

BACKGROUND: A retrospective review of 28 patients who had "house flap" anoplasty was carried out to evaluate the therapeutic effectiveness of the procedure. METHODS: House flap anoplasty was performed at Istanbul University Cerrahpasa Medical School, General Surgery Department, in 28 patients over 4 years. Indications were chronic anal fissure, anal stenosis, high transsphincteric fistula, low rectovaginal fistula, anal neoplasia, and obstetric third-degree perineal tear and incontinence. After rectangular excision of the anal or perianal lesion, the "walls" and "roof" of the house flap were incised to the depth of ischiorectal fat. The "base" of this house-shaped flap was then fixed to the top of the excised area. RESULTS: Median postoperative hospital stay was 4.86 (range = 2-12) days. Postoperative complications included three patients with minimal wound dehiscence and one with rectovaginal fistula recurrence. At a median follow-up of 26.4 (range = 1-46) months, excluding the patient with recurrence, all patients were satisfied with house flap anoplasty. CONCLUSION: House advancement flap anoplasty is a relatively simple procedure, combining the beneficial features of rectangular flaps and V-Y plasties. It can be used in nearly all types of anoderm deficiencies with a high rate of success and patient satisfaction.

An intraluminal leiomyoma of the small intestine causing invagination and obstruction: a case report.

Leiomyomas are mostly of benign character and are rarely seen in the gastrointestinal (GI) system. They represent one subgroup of a group of tumors known as gastrointestinal stromal tumors (GIST). Although rarely seen, they are symptomatic tumors, and they comprise 20-30 percent of all benign GI tumors. Diagnosis is difficult because of their rarity and the absence of specific symptoms. This is a case report of intestinal leiomyoma in a patient who was suffering with GI obstruction for more than 5 months. The tumor was discovered only after the appearance of intestinal obstruction. The patient underwent laparotomy for ileus of unknown etiology. Leiomyoma was diagnosed by pathologic analysis.