Surgical Managements of Anal Stricture

Lee, Chul Ho; Park, Won Kap; Lee, Kwang Real; Yoo, Jung Jun; Park, Se Yong

Abstract

Anal stricture is a mechanical narrowing of the anal canal due to contracture of the epithelial lining which has been supplanted by fibrous connective tissue. We reviewed 82 patients with anal strictures who were admitted at Song-Do Colorectal Hospital from Jan. 1994 to Dec. 1996. The etiology of the strictures were injection therapy with necrotizing agent in 62 patients(78%), secondary to hemorrhoid and fistular operations in 13 patients(17%), and other causes in 7 patients(8.5%). The degree of anal stricture was mild in 40 patients, moderate in 33 patients, and severe in 9 patients. The operation methods used to treat the anal strictures were infernal sphincterotomy in 27 patients, local advancement flap in 42 patients, and rotational flap in 13 patients; the selection of the operation method was based on the cause, severity and level of the stricture. During the local advancement or rotational flap operation, a concurrent internal sphincterotomy was also employed in selected patients who had a fibrotic muscular component contributing to the stricture. We preferred to use a sliding skin graft in the advancement flap operation and a C-flap in rotational flap operation. According to a follow-up study with an average follow-up of 20 months, 24 of the 27 patients with mild stricture, 19 of the 24 patients with moderate stricture, and 7 of the 8 patients with severe stricture had good results, and remained 3 patients with mild stricture, 5 patient with moderate stricture, and 1 patient with severe stricture had fair results. Mild anal strictures were effectively treated by sphincterotomy or one or two sliding skin grafts, moderate to severe anal strictures with diaphragmatic type were treated by anorectoplasty, and moderate to severe low anal stoictures with annular type were effectively treated by two or three sliding skin grafts. Based on these results, sliding skin grafts should be effective in most cases of moderate to severe anal canal stricture, although occasionally a rotational flap may be indicated in cases of severe lack of the anoderm.