Treatment of Iatrogenic Anal Stricture
Anal stenosis is an abnormal narrowing deformation of the anal canal. The anal canal become unable to extend during defecation, due to tissue cicatrization and loss of elasticity
The aim of the study. 1. Careful selection of different anoplasty techniques according to the size and shape of the stenosis. 2. Describing the results of anoplasty operations after 3 months.
Material and methods. The study includes 7 patients operated on for critical anal stricture during a 10-year period, with ages ranging from 22 to 76. Anal stenoses were complications of prior anorectal surgery. Seven reconstructive operations were performed. Five conservative excisions of scar tissue using the Y-V anoplasty for covering the tissue defect. In one case of cicatrization after improperly performed Whitehead hemorrhoidectomy, two S-shaped rotational flaps were used. Another patient was treated by radial incision of the stricture and internal sphincterotomy.
Results. In all but one patient, durable anal dilatation was achieved. One patient developed late recurrent anal stricture. She was successfully reoperated after 6 years using internal sphincterotomy and a mucosal advancement flap.
Conclusions. Various surgical techniques, such as the incision of the scar and internal anal sphincter, removal of scar tissue and covering the defects with well vascularized skin flaps, are available for management of anal stenosis. Early complications like visible wound dehiscence in the donor site or translocated flaps and local infection may occur. In most cases, they are amenable to medical management and do not affect functional results.