Diamond flap anoplasty combined with tailored lateral internal sphincterotomy for cicatricial anal stenosis ; a preliminary report

Abstract EN

Background / Aim : Cicatricle stenosis of the anal canal is a serious and disabling complication of anal surgery, which may be extremely difficult to manage.

The aim of this study was to assess the outcome of diamond-shaped flap anoplasty in the treatment of moderate to severe forms of cicatricial anal stenosis at intermediate level.

Patients and Method : from March 2002 to March 2004, ten patients with moderate to severe cicatricial anal stenosis were treated by tailored lateral internal sphincterotomy in the 3 o'clock position.

Concomitantly, diamond-shaped island flap of perianal skin were created and advanced into the anal canal to remedy the stricture.

The defect lateral to the advanced flap was sutured closed.

The mean follow-up period was 21 months.

The parameters of assessment were; postoperative pain, pruritus, healing, and off-work time, anal incontinence, recurrence of stenosis, and overall patients' satisfaction.

Results : mean pain score was 3 and mean healing and off-work times were 18 and 12 days respectively.

Postoperative pruritus occurred in 3 patients, temporary minor incontinence in one patient, and partial suture flap dehiscence was observed in one patient.

There was no reoperation for recurrence of stenosis.

The overall patients' satisfaction was good in 90 %.

Conclusion : this technique is easy to perform, successful in alleviating anal stenosis and maintaining fecal continence.

It seems more reliable because of the reduced tension at the suture line and the better blood supply to the flap.