Rhomboid-shaped advancement flap anoplasty to treat anal stenosis

Sloane, Jake; Zahid, Assad; Young, Christopher J.

doi:10.1007/s10151-016-1560-1

Cited by 11 publications

(18 citation statements)

References 3 publications

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“…Recently, Sloane et al . described a series of nine patients having rhomboid flaps (one unilateral and eight bilateral) and reported only one patient needing to continue with an anal dilator to prevent recurrent stenosis for 4 months from surgery [28].…”

Section: Discussionmentioning

confidence: 99%

A tailored rhomboid mucocutaneous advancement flap to treat anal stenosis

Gallo

Stratta

Luc³

et al. 2020

Colorectal Disease

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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.

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Section: Discussionmentioning

confidence: 99%

A tailored rhomboid mucocutaneous advancement flap to treat anal stenosis

Gallo

Stratta

Luc³

et al. 2020

Colorectal Disease

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“…Mucosal advancement flaps were fashioned in the submucosal plane as a tapered flap (broader proximally) and secured over the internal opening which was excised and closed with an absorbable suture. Anocutaneous flaps were created by one of two methods: if large skin tags or haemorrhoids were present, they were dissected, mobilized and rotated into position as the skin flap; otherwise, a rhomboid‐shaped flap was created in the perianal skin and then rotated into position, in a technique previously described [6]. Fistula plugs (Surgisis, Cook Surgical Inc., Bloomington, Indiana, USA) were inserted after cleaning the tract with normal saline and hydrogen peroxide [7] and secured at the internal and external openings after suture closure of the internal opening.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with healing, reoperation and continence disturbance in patients following surgery for fistula‐in‐ano

Kwok

Young

2020

Colorectal Disease

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Aim Fistula-in-ano (FIA) is associated with high treatment costs and has a deleterious impact on quality of life. A wide range of healing, incontinence and recurrence rates have been reported. This study aimed to identify operative, patient and disease factors that influence these outcomes after surgery for FIA. Method An observational cohort study of consecutive patients who were managed for FIA at a tertiary colorectal practice (1999-2019) was performed. Outcome measures included healing, impaired continence and the need to reoperate. Clinico-pathological variables, including patient comorbidities, fistula anatomy and operative approach, were assessed for their association with these outcomes. Results Some 411 procedures were performed on 263 patients [median age 41.8 years (range 17.8-79.7 years), 184 men (70.0%)]. Some 77.9% of patients achieved complete healing, 9.5% experienced some deterioration in continence postoperatively and 37.6% required reoperation at a median time of 19.0 weeks. Poorer healing was associated with Crohn's disease, high trans-sphincteric fistulas, extrasphincteric fistulas and steroid usage. Poorer continence was associated with female sex, age > 40 years, posterior location, suprasphincteric fistulas, seton insertion and having more than three subsequent procedures. The need to reoperate was associated with female sex, high transsphincteric fistulas, suprasphincteric fistulas, inflammatory bowel disease and previous operations for FIA. Conclusion Minimizing recurrence of FIA and preservation of continence can be competing management goals. More than one in three patients require reoperation, one in five fails to heal completely and one in ten suffers worsened continence following surgery. Awareness of the factors that contribute to these outcomes is important to the process of informed consent and managing patient expectations before surgery.

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“…The rhomboid flap has been modified in terms of the flap size to be adjusted to each patient. Sloane et al observed good functional results in a case series including nine patients, eight of whom underwent bilateral rhomboid flap with complete resolution of symptoms [ 28 ]. The modified rhomboid flap is demonstrated as a safe and suitable technique for the treatment of moderate and severe AS.…”

Section: Surgical Techniquesmentioning

confidence: 99%

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

et al. 2022

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Anal stenosis, which develops as a result of aggressive excisional hemorrhoidectomy, especially with the stoutly use of advanced technologies (LigaSure®, ultrasonic dissector, laser, etc.), has become common, causing significant deterioration in the patient’s quality of life. Although non-surgical treatment is effective for mild anal stenosis, surgical reconstruction is unavoidable for moderate to severe anal stenosis that causes distressing, severe anal pain, and inability to defecate. The problem in anal stenosis, unlike anal fissure, is that the skin does not stretch as a result of chronic fibrosis due to surgery. Therefore, the application of lateral internal sphincterotomy does not provide satisfactory results in the treatment of anal stenosis. Surgical treatment methods are based on the use of flaps of different shapes and sizes to reconstruct the anal caliber and flexibility. This article aims to summarize most-used surgical techniques for anal stenosis regarding functional and surgical outcomes.

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Rhomboid-shaped advancement flap anoplasty to treat anal stenosis

Cited by 11 publications

References 3 publications

A tailored rhomboid mucocutaneous advancement flap to treat anal stenosis

A tailored rhomboid mucocutaneous advancement flap to treat anal stenosis

Factors associated with healing, reoperation and continence disturbance in patients following surgery for fistula‐in‐ano

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

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