Abstract
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.
Highlights
Anal stenosis (AS) is defined as anatomical or functional narrowing of the anal canal, which can result from inflammatory bowel diseases, radiation therapy, congenital malformations, or excisional hemorrhoidectomy [1,2]
The incidence of AS is reported to be as high as 5%, and patients usually present with burdensome symptoms such as severe constipation, outlet obstruction, and anal pain, which cannot be alleviated with stool softeners or dietary changes [3,5,6]
Considering the fact that with today’s technological evolution, there are many alternative techniques such as doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy, and excisional hemorrhoidectomy may not be the only option for many patients [36]
Summary
Anal stenosis (AS) is defined as anatomical or functional narrowing of the anal canal, which can result from inflammatory bowel diseases, radiation therapy, congenital malformations, or excisional hemorrhoidectomy [1,2]. The anatomical AS is related to the increased fibrous scar tissue forming, which disables stretching of the anal canal [3]. Non-operative management, including mechanical dilatation, fiber supplements, and stool softeners, may achieve good results in selected cases with mild AS [8,9]. Operative treatment is inevitable for moderate AS refractory to non-operative management and severe AS. Mild: Tight anal canal can be examined by a well-lubricated index finger or a medium Hill-Ferguson retractor. Moderate: Forceful dilatation is required to insert either the index finger or a medium Hill-Ferguson retractor. Severe: Neither the little finger nor the small Hill-Ferguson retractor can be inserted unless a forceful dilatation is employed. This article aims to review the operative treatment methods regarding functional results, postoperative care, and complications
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