A tailored rhomboid mucocutaneous advancement flap to treat anal stenosis

Abstract

Aim Anal stenosis (AS) is a rare but disabling disorder that often represents a complication of anorectal surgery. The aim of our study was to assess the safety and functional outcome of a modified rhomboid flap (MRF) in the treatment of moderate and severe AS. Methods Between January 2002 and September 2017, 50 consecutive patients with moderate and severe AS who underwent an MRF were retrospectively included. Anal continence (Cleveland Clinic Incontinence Score) and symptoms (Obstructed Defaecation Syndrome Score) were assessed preoperatively and postoperatively at 12 months. Furthermore, anal calibre was measured both preoperatively and postoperatively at 1, 6 and 12 months. Results The mean follow-up period was 97 AE 48.3 (33-180) months. The main aetiology was a previous excisional haemorrhoidectomy (N = 23; 46%). The mean preoperative anal calibre was 9.96 AE 2.68 (5-15) mm and there was a statistically significant improvement in all three periods (P < 0.0001) of postoperative evaluation (1, 6 and 12 months) with a mean difference, obtained comparing preoperative and 12 months anal calibre, of 14.1 AE 2.72 (P < 0.0001). Statistically significant improvement in both Cleveland Clinic Incontinence Score and Obstructed Defaecation Syndrome Score was observed in all patients at 12 months. The overall success rate was 96% (48/50 patients). Conclusion The use of an MRF is a safe and suitable option for the treatment of moderate and severe AS. The possibility of tailoring the flap, based on the degree as well as the level of AS, is the key.

Anoplasty for Fused Anus Following Fournier’s Gangrene Debridement: a Case Report

“…Tailored rhomboid mucocutaneous advancement ap case series of 50 patients by Gallo G et al, reported a success rate of 96% with no recurrence. Bilateral advancement ap was performed for three patients as anal caliber was not satisfactory after the unilateral procedure [7]. Farid et al, had done a prospective study comparing anoplasty measure between house advancement ap, rhomboid, and V-Y anoplasty randomizing the cases with no signi cant difference in caliber of anal canal preoperatively, and has showed highest initial and long term clinical improvement in house advancement ap.…”

New Techniques in Hemorrhoidal Disease but the Same Old Problem: Anal Stenosis

“…The modified rhomboid flap is demonstrated as a safe and suitable technique for the treatment of moderate and severe AS. Gallo et al reported 0% recurrence rate and 96% success rate in a study with 50 consecutive patients, and significant improvement in the obstructed defecation syndrome scores and the quality of life were observed at 12 months [ 29 ]. The mean anal caliber was found to be 24 mm and significantly different compared to the preoperative measurement.…”

Evolution of Surgical Management of Hemorrhoidal Disease: An Historical Overview

“…He highlighted that no skin sacrifices would have occurred. The operation gained wide popularity in the following decades, which gradually decreased in the 20th century due to the high rate of complications reported, such as anal stenosis, incontinence, or persistent soiling due to mucosal ectropion and deformity (also called “Whitehead's anus”) ( 32 ). In 1924, J. Lockhart-Mummery declared that the death knell of Whitehead operations had been sounded during the London meeting of the American Proctologic Society ( 33 ).…”