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Anal Stenosis

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Complications of Anorectal Surgery

Abstract

Anal stenosis is the result of loss of anoderm with scarring and fibrosis, and typically occurs after anorectal procedures in adults, and after pull-through procedures in children. Anal stenosis is classified by severity, location, and extent of the stenosis. Conservative measures with stool softeners/bulking agents and anal dilation may relieve symptoms in some patients with mild disease. For those with more severe stenosis, operative treatment is indicated, and a variety of procedures are available to the surgeon. Sliding, island, and rotational flaps are well described and are typically the first line surgical option. For those with very short stenoses, such after anastomoses or stapled hemorrhoidopexy, lesser procedures such as stricturotomy and stricturoplasty may have some role in treatment. In children, dilation is the first line treatment option, followed by surgical intervention if dilation fails. Determining the degree and extent of stenosis should guide the surgeon to individualize treatment for each patient with anal stenosis.

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References

  1. Khubchandani IT. Mucosal advancement anoplasty. Dis Colon Rectum. 1985;28:194–6.

    Article  CAS  PubMed  Google Scholar 

  2. Shawki S, Costedio M. Anal fissure and stenosis. Gastroenterol Clin N Am. 2013;42:729–58.

    Article  Google Scholar 

  3. Liberman H, Thorson AG. Anal Stenosis. Am J Surgery. 2000;179:325–9.

    Article  CAS  Google Scholar 

  4. Caplin DA, Kodner IJ. Repair of anal stricture and mucosal ectropion by simple flap procedures. Dis Colon Rectum. 1986;29:92–4.

    Article  CAS  PubMed  Google Scholar 

  5. Rosen L. V-Y Advancement for anal ectropion. Dis Colon Rectum. 1986;29:596–8.

    Article  CAS  PubMed  Google Scholar 

  6. Ferguson JA. Repair of “Whitehead deformity” of the anus. Surg, Gynec, Obst. 1959;108:115.

    CAS  Google Scholar 

  7. Hudson AT. S-Plasty repair of Whitehead Deformity of the Anus.

    Google Scholar 

  8. Faulconer HT, Ferguson JA. Anal S-Plasty for “Whitehead Deformity”. Dis Colon Rectum. 1973;16:388–91.

    Article  CAS  PubMed  Google Scholar 

  9. Oh C, Zinberg J. Anoplasty for anal stricture. Dis Colon Rectum. 1982;25:809–10.

    Article  CAS  PubMed  Google Scholar 

  10. Maria G, Brisinda G, Civello IM. Anoplasty for the treatment of anal stenosis. Am J Surg. 1998;175:158–60.

    Article  CAS  PubMed  Google Scholar 

  11. Bonello JC. Who’s Afraid of the Dentate line? The whitehead hemorrhoidectomy. Am J Surg. 1988;156:182–6.

    Article  CAS  PubMed  Google Scholar 

  12. Brisinda G, Vanella S, Cadeddu F, et al. Surgical treatment of anal stenosis. World J Gasroenterol. 2009;15:1921–8.

    Article  Google Scholar 

  13. Milsom JW, Mazier WP. Classification and management of postsurgical anal stenosis. Surg, Gynec Obst. 1986;163:60–4.

    CAS  Google Scholar 

  14. Sagar PM, Pemberton JH. Intraoperative, postoperative and reoperative problems with ileoanal pouches. Br J Surg. 2012;99:454–68.

    Article  CAS  PubMed  Google Scholar 

  15. Kumar A, Daga R, Vijayaragavan P, et al. Anterior resection for rectal carcinoma-Risk factors for anastomotic leaks and strictures. World J Gastroenterol. 2011;17(11):1475–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Couto RA, Zequeira JJ, Vicente HL. Recalcitrant coloanal strictures in children managed by transanal circular stapled anastomosis. J Pediatric Surg. 2014;49:1686–8.

    Article  Google Scholar 

  17. Shimada S, Matsuda M, Uno K, et al. A new device for the treatment of coloproctostomic stricture after double stapling anastomosis. Ann Surg. 1996;224:603–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Pearl RK, Hooks VH, Abcarian H, Orsay CP, Nelson RL. Island flap anoplasty for the treatment of anal stricture and mucosal ectropion. Dis Col Rectum. 1990;33:581–3.

    Article  CAS  Google Scholar 

  19. Katdare MV, Ricciardi R. Anal stenosis. Surg Clin N Am. 2010;90:137–45.

    Article  PubMed  Google Scholar 

  20. Levitt MA, Pena A. Chapter 20: Operative management of anomalies in males. In: Holschneider AM, Hutson JM, editors. Anorectal Malformations in children. Berlin, Heidelberg, New York: Springer; 2006. p. 295–302.

    Google Scholar 

  21. Mueller CM, Beaunoyer M, St-Vil D. Topical Mitomycin-C for the treatment of anal stricture. J Pediatr Surg. 2010;45:241–4.

    Article  PubMed  Google Scholar 

  22. Dietz DW. Ch 10: Postoperative complications, In: Beck DE, Roberts PL, Saclarides TJ, et al, eds. The ASCRS textbook of Colon and Rectal Surgery, 2nd edition, Springer New York, 2011, pp 157–173.

    Google Scholar 

  23. Kanellos I, Blouhos K, Demetriades H, et al. Pneumomediastinum after dilation of anal stricture following stapled hemorrhoidopexy. Tech Coloproctol. 2004;8:185–7.

    Article  CAS  PubMed  Google Scholar 

  24. MacDonald A, Smith A, McNeill AD, et al. Manual dilation of the anus. Br J Surg. 1992;79:1381–2.

    Article  CAS  PubMed  Google Scholar 

  25. Rakhmanine M, Rosen L, Khubchandani I, Stasik J, Riether RD. Lateral mucosal advancement anoplasty for anal stricture. Br J Surg. 2002;89:1423–4.

    Article  CAS  PubMed  Google Scholar 

  26. Gingold BS, Arvanitis M. Y-V anoplasty for treatment of anal stricture. Surg Gynec Obst. 1986;162:241–2.

    CAS  Google Scholar 

  27. Angelchik PD, Harms BA, Starling JR. Repair of anal stricture and mucosal ectropion with Y-V or pedicle flap anoplasty. Am J Surg. 1993;166:55–9.

    Article  CAS  PubMed  Google Scholar 

  28. Farid M, Youssef M, El Nakeeb A, Fikry A, El Awady S, Morshed M. Comparative study of the house advancement flap, rhomboid flap and Y-V anoplasty in treatment of anal stenosis: a prospective randomized study. Dis Colon Rectum. 2010;53:790–7.

    Article  PubMed  Google Scholar 

  29. Christensen MA, Pitsch RM, Cali RL, Blatchford GJ, Thorson AG. “House” Advancement pedicle flap for anal stenosis. Dis Colon Rectum. 1992;35:201–3.

    Article  CAS  PubMed  Google Scholar 

  30. Anderson KD, Newman KD, Bond SJ, Sherman NJ. Diamond flap anoplasty in infants and children with an intractable anal stricture. J Pediatr Surg. 1994;29:1253–7.

    Article  CAS  PubMed  Google Scholar 

  31. Gonzalez AR, De Oliveira O, Verzaro R, Nogueras J, Wexner SD. Anoplasty for stenosis and other anorectal defects. Am Surg. 1995;61:526–9.

    CAS  PubMed  Google Scholar 

  32. Guerra F, Crocetti D, Giuliani G, et al. Surgery for anorectal strictures following stapled procedure (letter). Colorectal Dis. 2015;17:265–70.

    Article  Google Scholar 

  33. Rees JRE, Carney L, Gill TS, Dixon AR. Management of recurrent anastomotic stricture and iatrogenic stenosis by circular stapler. Dis Colon Rectum. 2004;47:944–7.

    Article  CAS  PubMed  Google Scholar 

  34. Brisighelli G, Morandi A, Di Cesare A, Leva E. The practice of anal dilations following anorectal reconstruction in patients with anorectal malformation: An international survey. Eur J Pediatr Surg. 2016; Jan 14 (e pub ahead of print).

    Google Scholar 

  35. Jenetzky E, Reckin S, Schmiedeke E, et al. Practice of anal dilatation after surgical correction in anorectal malformations. Pediatr Surg Int. 2012;28(11):1095–9.

    Article  PubMed  Google Scholar 

  36. Levitt MA, Pena A. Chapter 24: Complications after the treatment of anorectal malformations and redo operations. In: Holschneider AM, Hutson JM, editors. Anorectal Malformations in children. Berlin, Heidelberg, New York: Springer; 2006. p. 319–28.

    Google Scholar 

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Authors and Affiliations

  1. Colon and Rectal Surgery Residency Program, Stroger Hospital of Cook County, 1900 W. Polk St, Room 406, Chicago, IL, 60612, USA

    Jennifer Blumetti

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  1. Jennifer Blumetti
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Correspondence to Jennifer Blumetti .

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Editors and Affiliations

  1. Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois, USA

    Herand Abcarian

  2. Division of Colon and Rectal Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA

    Jose Cintron

  3. Epidemiology/Biometry Division, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA

    Richard Nelson

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Blumetti, J. (2017). Anal Stenosis. In: Abcarian, H., Cintron, J., Nelson, R. (eds) Complications of Anorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-48406-8_13

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  • DOI: https://doi.org/10.1007/978-3-319-48406-8_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-48404-4

  • Online ISBN: 978-3-319-48406-8

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