1
|
Matsumoto R, Kamada T, Aida T, Ohdaira H, Yamanouchi E, Suzuki Y. Balloon dilatation followed by triamcinolone acetonide injection for colostomy stenosis: A case report. Int J Surg Case Rep 2024; 121:110056. [PMID: 39029215 PMCID: PMC11315068 DOI: 10.1016/j.ijscr.2024.110056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Stenosis is a serious complication associated with stomas. The initial treatment for stoma stenosis is mainly the finger-bougie technique or balloon dilatation, and recurrence requires stomal reconstruction. However, the use of local triamcinolone injections for treating stoma stenosis has not been reported. Herein, we reported a case of repeated stoma stenosis in a high-risk patient in whom balloon dilatation combined with local triamcinolone injection effectively avoided stomal reconstruction. PRESENTATION OF CASE A woman in her 70s was admitted to our hospital with the chief complaint of a positive fecal occult blood test and was diagnosed with Ra advanced rectal cancer. Owing to the presence of multiple comorbidities, a laparoscopic Hartmann procedure with D3 dissection was performed. The operative time was 165 min and the intraoperative blood loss was 5 mL. On postoperative day 2, the colostomy stump became discolored, and stoma necrosis was diagnosed, which was successfully treated conservatively, with no findings of stoma falling or peritonitis. Six months after surgery, late stoma stenosis causing colonic obstruction was diagnosed, and the finger-bougie technique and balloon dilatation were ineffective. To avoid reoperation under general anesthesia, balloon dilatation using a CRE™ PRO GI Wireguided (Boston Scientific) at 19 mm for 3 min combined with a 40 mg injection of local triamcinolone into the stoma orifice scar was successfully performed. DISCUSSION No restenosis was observed after treatment. CONCLUSION Balloon dilatation combined with local triamcinolone injections may be effective for recurrent stoma stenosis in patients with high-risk comorbidities after rectal cancer surgery.
Collapse
Affiliation(s)
- Ryohei Matsumoto
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan.
| | - Takashi Aida
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Eigoro Yamanouchi
- Department of Radiology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan
| |
Collapse
|
2
|
Haraguchi T, Emoto T. Stimulus-Response Plots as a Novel Bowel-Sound-Based Method for Evaluating Motor Response to Drinking in Healthy People. SENSORS (BASEL, SWITZERLAND) 2024; 24:3054. [PMID: 38793909 PMCID: PMC11125318 DOI: 10.3390/s24103054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
Constipation is a common gastrointestinal disorder that impairs quality of life. Evaluating bowel motility via traditional methods, such as MRI and radiography, is expensive and inconvenient. Bowel sound (BS) analysis has been proposed as an alternative, with BS-time-domain acoustic features (BSTDAFs) being effective for evaluating bowel motility via several food and drink consumption tests. However, the effect of BSTDAFs before drink consumption on those after drink consumption is yet to be investigated. This study used BS-based stimulus-response plots (BSSRPs) to investigate this effect on 20 participants who underwent drinking tests. A strong negative correlation was observed between the number of BSs per minute before carbonated water consumption and the ratio of that before and after carbonated water consumption. However, a similar trend was not observed when the participants drank cold water. These findings suggest that when carbonated water is drunk, bowel motility before ingestion affects motor response to ingestion. This study provides a non-invasive BS-based approach for evaluating motor response to food and drink, offering a new research window for investigators in this field.
Collapse
Affiliation(s)
- Takeyuki Haraguchi
- Science and Technology, Graduate School of Sciences and Technology for Innovation, Tokushima University, Tokushima 770-8506, Japan;
| | - Takahiro Emoto
- Division of Science and Technology, Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima 770-8506, Japan
| |
Collapse
|
3
|
Wei D, Jiang P, Gao R, Zhao Y. Prevention of Rectal Stenosis After Procedure for Prolapse and Hemorrhoids by Anastomotic Thread-Drawing and Anal Enlargement. Am Surg 2023; 89:5932-5939. [PMID: 37257493 DOI: 10.1177/00031348231180925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH) and to intervene early. METHODS A total of 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022 were randomly divided into the experimental group and control group A, B, and C, with 100 patients in each group. Experimental group: Thread-drawing during operation and anal enlargement after PPH. Group A: Thread-drawing during PPH surgery, group B: Anal enlargement after PPH, and group C: PPH alone. The anastomotic sites of the 4 groups were observed for 1-2 months and followed up for 1-3 years. RESULTS The effective rate of mixed hemorrhoid treatment in the 4 groups was 100%. There was no rectal stenosis in the experimental group, 11% in group A, 7% in group B, and 14% in group C. CONCLUSION Multipoint thread-drawing and anal enlargement after PPH can avoid postoperative rectal stenosis and can strengthen anastomosis and reduce bleeding, while being a simple procedure that can be easily popularized.
Collapse
Affiliation(s)
- Dan Wei
- Department of General Surgery, Characteristic Medical Centre of Strategic Support Force, Beijing, China
| | - Peng Jiang
- Health Team of Comprehensive Training Brigade of Strategic Support Force, Beijing, China
| | - Ran Gao
- Department of General Surgery, Characteristic Medical Centre of Strategic Support Force, Beijing, China
| | - Yan Zhao
- Department of General Surgery, Characteristic Medical Centre of Strategic Support Force, Beijing, China
| |
Collapse
|
4
|
Nakatsuka K, Karakawa R, Fuse Y, Yoshimatsu H, Yano T. Bilateral Transposition Flap for Postoperative Anal Stenosis after Reconstruction for Paget Disease. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5142. [PMID: 37547347 PMCID: PMC10400041 DOI: 10.1097/gox.0000000000005142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/12/2023] [Indexed: 08/08/2023]
Abstract
One of the complications of anal surgery or disease is anal stenosis. To release the tension of the anus, a tension-releasing incision in the perianal skin and various anoplasty procedures are usually considered. The aim of this article is to describe a straightforward technique with local flaps for severe anal stenosis after anal reconstruction. A 57-year-old man presented to the clinic with diverticulitis secondary to severe anal stenosis, and reported difficulty with defecation after perianal skin resection around the anus and surgery to create a V-Y advancement flap for perianal primary Paget disease 9 months previously. After improvement of the diverticulitis using antibiotics, bilateral transposition flaps were transferred to release the anal stenosis. The surgical treatment for severe anal stenosis has been known to entail several complications, including infection, incontinence, anal mucosal ectropion, pruritus, wound dehiscence, and restenosis. In this severe case, because the scars were situated at the 6 o'clock and 12 o'clock positions on the anus due to the previous V-Y advancement flap, bilateral rotation flaps were transferred from the 3 o'clock and 9 o'clock positions of the anus to prevent wound dehiscence and partial flap necrosis. Three months later, the size of the anus was unchanged, but additional surgery was performed at the patient's request. A bilateral transposition flap procedure was used, with flaps designed and elevated from the 6 o'clock and 12 o'clock positions. The postoperative course was uneventful, and the anal stenosis was improved.
Collapse
Affiliation(s)
- Kengo Nakatsuka
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryo Karakawa
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuma Fuse
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoyuki Yano
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
5
|
Christodoulou P, Baloyiannis I, Perivoliotis K, Symeonidis D, Tzovaras G. The role of the Rafaelo procedure in the management of hemorrhoidal disease: a systematic review and meta-analysis. Tech Coloproctol 2023; 27:103-115. [PMID: 36371772 DOI: 10.1007/s10151-022-02730-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to summarize the current evidence regarding the role of the Rafaelo procedure in the management of hemorrhoidal disease (HD). METHODS This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed (Medline, Scopus, CENTRAL, and Web of Science) from inception to 25/09/2022. Grey literature databases were also reviewed. The primary endpoint was the pooled complications rate of the Rafaelo procedure in patients with HD. Secondary endpoints included short- (bleeding, pain, thrombosis, necrosis, urinary retention, fever, oedema, anal fissure, and readmission) and long-term (stenosis, meteorism, constipation, anal tags, anal hyposensibility, reoperation, and recurrence) postoperative complication rates. Both prospective and retrospective studies were considered. Quality evaluation was performed via the ROBINS-I tool. Certainty of Evidence was based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. RESULTS Overall, 6 non-randomized studies and 327 patients were included. The overall complication rate was 17.6% (95% CI 8.8-26.3%). Short-term complications were bleeding (7.5%, 95% CI 2.5-12.5%), thrombosis (2.2%, 95% CI 0.4-4.8%), and pain (1.6%, 95% CI 0.2-3.3%). Reoperation and recurrence rates were 1.8% (95% CI 0.3-3.4%) and 4.8% (95% CI 1.2-8.4%), respectively. A significant improvement in the presenting symptoms was noted. Method approval and patient satisfaction rates were 89.1% (95% CI 81.7-96.6%) and 95% (95% CI 89.8-100%), correspondingly. Overall CoE was "Very Low". CONCLUSIONS Further randomized controlled trials are required to delineate the exact role of the Rafaelo procedure in HD.
Collapse
Affiliation(s)
| | | | | | | | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| |
Collapse
|
6
|
Karaçay Ş, Yılmaz D, Ugras M. Evaluation of Patients With Congenital Anal Stenosis, Single Center Study. Clin Med Insights Pediatr 2023; 17:11795565221150193. [PMID: 36741422 PMCID: PMC9893400 DOI: 10.1177/11795565221150193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/22/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Şafak Karaçay
- Pediatric Surgery Clinic, Faculty of
Medicine, Yeditepe University, İstanbul, Turkey,Şafak Karaçay, Pediatric Surgery Clinic,
Faculty of Medicine, Yeditepe University, Içerenköy Mah. Hastane Sok. No:4
D:4/1, Istanbul 34854, Turkey.
| | - Duygu Yılmaz
- Pediatrics Clinic, Faculty of Medicine,
Yeditepe University, İstanbul, Turkey
| | - Meltem Ugras
- Pediatric Gastroenterology Clinic,
Faculty of Medicine, Yeditepe University, İstanbul, Turkey
| |
Collapse
|
7
|
Kamabu K, Geoffrey OO, Kiyaka SM, Francis MO, Arab AM, Sikakulya FK. House advancement flap anoplasty in anal stenosis post hemorrhoids surgery. A case report. Int J Surg Case Rep 2023; 103:107894. [PMID: 36640463 PMCID: PMC9840350 DOI: 10.1016/j.ijscr.2023.107894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Anal stenosis following hemorrhoids surgery is rare, and very distressing to the patients. It is graded according to its severity namely mild, moderate or severe. Majority of severe cases require surgery. The treatment is complex shown by the multiplicity of flaps and techniques described in the literature. This case report then reminds surgeons about the complications of hemorrhoidectomy and the complexity of their management. In addition, it challenges the surgeons about their practice on hemorrhoids. CASE PRESENTATION A 30-year-old male who presented with difficulty in passing stool with intermittent low abdominal pain for 4 weeks following a surgery for hemorrhoids. A House Advancement Flap was designed to match the transverse incisions and hence the width of the mucosal defect to be replaced. Any intra- or postoperative complications were noted and the patient was discharged on the second postoperative day from the hospital. Patient had no complaints in the post-discharge period. CLINICAL DISCUSSION Overzealous hemorrhoidectomy is one of the primary causes of stenosis of anal canal. Other causes that have been reported include anorectal diseases, other anorectal surgeries and radiotherapy. Physical examination majorly leads to the diagnosis of anal stenosis. Its treatment is conservative in mild cases while in severe anal stenosis a House Advancement Flap is one of the possible surgical management options. CONCLUSION Anal stenosis is a rare condition which requires good evaluation for its better management. Given its simplicity and successful results, a House Advancement Flap anoplasty is a reliable treatment of severe anal stenosis.
Collapse
Affiliation(s)
- Kinyamaniyi Kamabu
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda; Department of Surgery Lira Regional Referral Hospital, Uganda
| | | | - Sonye Magugu Kiyaka
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Mamadi Owera Francis
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda; Department of Surgery Lira Regional Referral Hospital, Uganda
| | - Abdikadar Mohamud Arab
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda; Department of Surgery Lira Regional Referral Hospital, Uganda
| | - Franck Katembo Sikakulya
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda; Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
| |
Collapse
|
8
|
Gallo G, Picciariello A, Di Tanna GL, Pelizzo P, Altomare DF, Trompetto M, Santoro GA, Roviello F, Felice C, Grossi U. Anoplasty for anatomical anal stenosis: systematic review of complications and recurrences. Colorectal Dis 2022; 24:1462-1471. [PMID: 35792887 PMCID: PMC10086798 DOI: 10.1111/codi.16248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
AIM The optimal surgical treatment for anatomical anal stenosis (AS) remains to be determined. The aim of this study was to determine the rates of complications and recurrence after anoplasty for anatomical AS and, wherever feasible, compare the outcomes for the various techniques. METHOD A PROSPERO-registered systematic review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, PubMed, Embase, Cochrane Library of Systematic Review, Scopus and Web of Science were searched for articles published up to May 2021. Studies that assessed the outcomes of anoplasty in adult patients with anatomical AS were selected. The primary outcomes were complications and recurrence. The methodological quality of studies was appraised using the Joanna Briggs Institute critical appraisal tools. RESULTS From the total of 2705 unique screened records, 151 were assessed for eligibility. Only 29 studies (two prospective) met the inclusion criteria, reporting data on 556 patients [mean age 53 (18-83) years, 46% female]. Previous history of surgery for haemorrhoidal disease accounted for three quarters of cases. A total of 14 types of anoplasty were found, with the Y-V flap being the most performed technique [27% of cases (n = 149)]. Complications frequently occurred, with a pooled prevalence of 10.2% (95% CI 3.9%-24.1%) after Y-V flap and 11.5% (5.3%-23.0%) after rhomboid/diamond flap. Patients undergoing house flap achieved better results in terms of clinical improvement, satisfaction and quality of life compared with Y-V flap and rhomboid/diamond flap. When considering only studies with at least 12 months of follow-up, the pooled prevalence of recurrence was 4.7% (2.2%-9.8%), with significantly higher rates observed in the prospective versus retrospective series [pooled prevalence 18.9% (11.5%-29.5%) vs. 3.6% (1.7-7.8%), respectively; p < 0.001]. CONCLUSION Both complications and recurrence were significantly lower after house flap compared with rhomboid/diamond and Y-V flap. Better designed multicentre studies with longer follow-up are needed to confirm these findings. PROSPERO REGISTRATION NUMBER CRD42021239493.
Collapse
Affiliation(s)
- Gaetano Gallo
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
| | - Arcangelo Picciariello
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationUniversity ‘Aldo Moro of Bari’BariItaly
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Patrizia Pelizzo
- II Surgery UnitRegional Hospital Treviso, AULSS2TrevisoItaly
- Department of Medicine – DIMEDUniversity of PaduaPaduaItaly
| | - Donato Francesco Altomare
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationUniversity ‘Aldo Moro of Bari’BariItaly
| | | | | | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
| | - Carla Felice
- Department of Medicine – DIMEDUniversity of PaduaPaduaItaly
| | - Ugo Grossi
- II Surgery UnitRegional Hospital Treviso, AULSS2TrevisoItaly
- Department of Surgery, Oncology and Gastroenterology – DISCOGUniversity of PaduaPaduaItaly
| |
Collapse
|
9
|
Weng YT, Chu KJ, Lin KH, Chang CK, Kang JC, Chen CY, Hu JM, Pu TW. Is anoplasty superior to scar revision surgery for post-hemorrhoidectomy anal stenosis? Six years of experience. World J Clin Cases 2022; 10:7698-7707. [PMID: 36158502 PMCID: PMC9372861 DOI: 10.12998/wjcc.v10.i22.7698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/19/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of hemorrhoidectomy. The severity of anal stenosis can be classified into three categories: mild, moderate, and severe. There are two main surgical treatments for this condition: scar revision surgery and anoplasty; however, no studies have compared these two approaches, and it remains unclear which is preferrable for stenoses of different severities.
AIM To compare the outcomes of scar revision surgery and double diamond-shaped flap anoplasty.
METHODS Patients with mild, moderate, or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and compared. The severity of stenosis was determined via anal examination performed digitally or using a Hill-Ferguson retractor. The explored patient characteristics included age, sex, preoperative severity of anal stenosis, preoperative symptoms, and preoperative adjuvant therapy; moreover, their postoperative quality of life was measured using a 10-point scale. Patients underwent proctologic follow-up examinations one, two, and four weeks after surgery.
RESULTS We analyzed 60 consecutive patients, including 36 men (60%) and 24 women (40%). The mean operative time for scar revision surgery was significantly shorter than that for double diamond-shaped flap anoplasty (10.14 ± 2.31 [range: 7-15] min vs 21.62 ± 4.68 [range: 15-31] min; P < 0.001). The average of length of hospital stay was also significantly shorter after scar revision surgery than after anoplasty (2.1 ± 0.3 vs 2.9 ± 0.4 d; P < 0.001). Postoperative satisfaction was categorized into four groups: 45 patients (75%) reported excellent satisfaction (scores of 8-10), 13 (21.7%) reported good satisfaction (scores of 6-7), two (3.3%) had no change in satisfaction (scores of 3-5), and none (0%) had scores indicating poor satisfaction (1-2). As such, most patients were satisfied with their quality of life after surgery other than the two who noticed no difference due owing to the fact that they experienced recurrences.
CONCLUSION Scar revision surgery may be preferable for mild anal stenosis upon conservative treatment failure. Anoplasty is unavoidable for moderate or severe stenosis, where cicatrized tissue is extensive.
Collapse
Affiliation(s)
- Yu-Tse Weng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | | | - Kuan-Hsun Lin
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chun-Kai Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Zuoying Branch, Kaohsiung Armed Forces General Hospital, Kaohsiung 813, Taiwan
| | - Jung-Cheng Kang
- Division of Colon and Rectal Surgery, Department of Surgery, Taiwan Adventist Hospital, Taipei 105, Taiwan
| | - Chao-Yang Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Je-Ming Hu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Songshan branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 105, Taiwan
| |
Collapse
|
10
|
Elfallal AH, Fathy M, Elbaz SA, Emile SH. Comprehensive literature review of the applications of surgical laser in benign anal conditions. Lasers Med Sci 2022; 37:2775-2789. [PMID: 35606626 DOI: 10.1007/s10103-022-03577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/14/2022] [Indexed: 10/18/2022]
Abstract
Surgery for benign anal conditions is a common practice and is usually followed by a good outcome. The present review aimed to summarize the emergence and evolution of different laser techniques used for the treatment of benign anal conditions and report their current outcome. PubMed and Scopus were searched for studies that assessed the use of laser in benign anal conditions. Anal conditions reviewed were hemorrhoids, anal fistula, anal warts, anal stenosis, and anal fissure. The full text of the studies retrieved was summarized in a narrative and tabular form. Laser techniques used for the treatment of hemorrhoidal disease were laser open hemorrhoidectomy, laser hemorrhoidoplasty, and Doppler-guided hemorrhoidal laser dearterialization. Resolution of hemorrhoidal symptoms was reported in 72-100% of patients after laser treatment. YAG laser, fistula laser closure, and photodynamic therapy have been used for the treatment of anal fistula with success rates ranging from 20 to 92.6%. Anal warts can be treated with photodynamic therapy with or without YAG or CO2 laser with a success rate up to 88%. A few studies reported the use of laser in the treatment of chronic anal fissure and anal stenosis. The use of laser in the treatment of benign anal conditions is associated with promising outcomes. Laser was most assessed in hemorrhoidal disease and anal fistula and showed more consistent success rates with hemorrhoidal disease than with anal fistula. Preliminary reports assessed the outcome of laser treatment in other conditions as anal fissure and warts with acceptable outcomes.
Collapse
Affiliation(s)
- Ahmed Hossam Elfallal
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt
| | - Mohammad Fathy
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt
| | - Samy Abbas Elbaz
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt
| | - Sameh Hany Emile
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt. .,Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
| |
Collapse
|
11
|
Leventoglu S, Mentes B, Balci B, Kebiz HC. New Techniques in Hemorrhoidal Disease but the Same Old Problem: Anal Stenosis. Medicina (B Aires) 2022; 58:medicina58030362. [PMID: 35334538 PMCID: PMC8954788 DOI: 10.3390/medicina58030362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/28/2022] Open
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.
Collapse
Affiliation(s)
- Sezai Leventoglu
- Department of General Surgery, Faculty of Medicine, Gazi University, Cankaya, Ankara 06560, Turkey
- Correspondence:
| | - Bulent Mentes
- Department of Surgery, Proctology, Ankara Memorial Hospital, Cankaya, Ankara 06520, Turkey;
| | - Bengi Balci
- Department of General Surgery, Ankara Oncology Training and Research Hospital, Yenimahalle, Ankara 06105, Turkey;
| | - Halil Can Kebiz
- Faculty of Medicine, Gazi University, Cankaya, Ankara 06560, Turkey;
| |
Collapse
|
12
|
Combination of simple advancement flap and fistulectomy to treat complex anal fistula as a complication of hemorrhoidectomy: Case report. Ann Med Surg (Lond) 2022; 73:103203. [PMID: 35028135 PMCID: PMC8715064 DOI: 10.1016/j.amsu.2021.103203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction After hemorrhoidectomy, anal stenosis occurs, which is an uncommon but severe consequence. The majority of severe cases require advancement flap anoplasty. Presentation of case A 50-year-old female patient with a history of hemorrhoidectomy 10 months prior to admission complained of difficulty defecating, pain, and incomplete evacuation sensation, as well as a hole on the right side of the anal canal through which feces unintentionally passed. On the physical examination, we found that the anal lumen was partially obstructed, which did not allow the insertion of a finger. There was an impression of a perineal fistula at 5 and 7 o'clock, which was connected to the anal canal 3 cm from the edge of the anus. The patient was diagnosed with severe anal stenosis with perianal fistula. The patient underwent fistulectomy and advancement flap with perianal skin. In the outpatient follow-up clinic in the first and second weeks, the patient showed no complications, and no recurrence of her complaints was found. Discussion Several corrective surgical techniques have been applied to restore a healthy lining to the constricted portion of the anal canal. We performed a combination of simple cutaneous advancement flap and fistulectomy to manage the patient with severe anal stenosis following hemorrhoidectomy with concurrent anal fistula. Conclusion A combination of fistulectomy and simple cutaneous advancement flap anoplasty is a simple, safe, and effective surgical option for the management of severe anal stenosis with concomitant anal fistula. Uncommon but severe consequence of hemorrhoidectomy is anal stenosis. A combination of fistulectomy and simple cutaneous advancement flap anoplasty is a simple, safe, and effective. First to report the combination of surgical technique in managing severe anal stenosis.
Collapse
|
13
|
Bejiga G. Bilateral house advancement flap anoplasty for severe anal stenosis secondary to traditional medicine application with excellent outcome: "Case report". Int J Surg Case Rep 2021; 90:106725. [PMID: 34968983 PMCID: PMC8717220 DOI: 10.1016/j.ijscr.2021.106725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Anal stenosis is narrowing of anal canal that may result from true anatomic stricture or functional stenosis. Anal stenosis from irritant chemical application for hemorrhoid is rare and tends to be more severe. There is scarcity of data in the literature regarding anal stenosis secondary to traditional medicine application for the treatment of hemorrhoid. This case report can create awareness to promote health education and health advancement, especially in areas with wide spread use of traditional medicine. In addition, it can motivate general surgeons to prepare themselves to handle such cases in the absence of colorectal surgeons. Presentation of the case A 75 years old male farmer presented with worsening of difficulty of passing feces and flatus and intermittent abdominal distention of 3 months. The patient has history of application of irritant chemical by traditional healer for treatment of hemorrhoid. Physical examination led to diagnosis of severe anal stenosis. Bilateral house advancement flap anoplasty done by a general surgeon with excellent result. Discussion The commonest cause of anal stenosis is hemorrhoidectomy. Other causes include other anorectal surgeries, anorectal diseases, and radiotherapy. Diagnosis of anal stenosis is by physical examination. Treatment is conservative for mild cases and advancement flap anoplasty for moderate to severe cases. Conclusion Health education and health advancement can create awareness, hence preventing people from having wrong treatments. House advancement flap anoplasty is a good option for the treatment of anal stenosis in resource limited setup, as it is easy to do and has good outcome. Anal stenosis as a complication of traditional medicine application for hemorrhoid is rare. House advancement flap anoplasty is a good option for moderate to severe anal stenosis. Anal stenosis following irritant chemical application to perineum tends to be severe.
Collapse
Affiliation(s)
- Gosa Bejiga
- Adama Hospital Medical College, Adama, P.O. Box: 84, Ethiopia.
| |
Collapse
|
14
|
Hancke E, Suchan K, Voelke K. Anocutaneous advancement flap provides a quicker cure than fissurectomy in surgical treatment for chronic anal fissure-a retrospective, observational study. Langenbecks Arch Surg 2021; 406:2861-2867. [PMID: 34159437 PMCID: PMC8803790 DOI: 10.1007/s00423-021-02227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
Purpose Anocutaneous advancement flap is a surgical procedure for the treatment of chronic anal fissures. This study aimed to assess the results of anocutaneous advancement flap in a consecutive cohort of patients. Methods This is a retrospective, observational study. From 2000 to 2011, 481 patients had been operated for a single chronic anal fissure at the Maingau Clinic of the German Red Cross in Frankfurt am Main. The intention was to excise the fissure by fissurectomy (FIS) and then to cover the wound primarily with an anocutaneous advancement flap (AAF). The primary outcomes were resolution of symptoms and healing rates 1 month postoperatively. Secondary outcomes included incidences of early and late complications, postoperative incontinence, and recurrent fissure. Results Anocutaneous advancement flap was performed in 455 (94.6%). In 26 (5.4%) patients, AAF failed due to lacking skin and the wound left open after FIS. One month postoperatively, half of the patients with AAF were free of symptoms (53.2%) with complete wound healing (47.9%). The incidence of early complications within 1 month postoperatively was 0.9% after AAF. From 1 month to 5 years after operation anal abscesses and fistula occurred in 2.9%. Mild symptoms of anal incontinence were recorded in 0.2% and recurrent chronic anal fissure in 3.3% of patients. Subgroup analysis revealed improved wound healing 1 month postoperatively in patients with AAF compared to FIS. Conclusion Anocutaneous advancement flap is a very safe sphincter-sparing surgical option for CAF, provides a quicker cure than fissurectomy, and may be considered a good first-line surgical treatment option for chronic anal fissures if medical treatment failed.
Collapse
Affiliation(s)
- Edgar Hancke
- Sektion Proktologie, Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Ketteler Krankenhaus Offenbach, Lichtenplattenweg 85, D-63071, Offenbach am Main, Germany. .,Centrum Coloproctologie, Klinik Maingau Vom Roten Kreuz, Eschenheimer Anlage 7, 60316, Frankfurt am Main, Germany.
| | - Katrin Suchan
- Centrum Coloproctologie, Klinik Maingau Vom Roten Kreuz, Eschenheimer Anlage 7, 60316, Frankfurt am Main, Germany
| | - Knut Voelke
- Centrum Coloproctologie, Klinik Maingau Vom Roten Kreuz, Eschenheimer Anlage 7, 60316, Frankfurt am Main, Germany
| |
Collapse
|
15
|
Unique hybrid double apposing flap in a Z-plasty technique to reconstruct major perianal defect resulting from chondyloma acuminatum resection - Case report. Int J Surg Case Rep 2021; 83:106002. [PMID: 34090197 PMCID: PMC8188379 DOI: 10.1016/j.ijscr.2021.106002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 11/23/2022] Open
Abstract
Perianal area is anatomically challenging location to reconstruct after wide extensive local excision especially when preserving the anus anatomy anal sphincter continence is a requirement. That is the case in many benign locally aggressive conditions, due to high risk of suture line disruption, wound dehiscence, and wound infection. Many surgical options like primary closure, loco reginal flaps, distant or pedicled flaps, or even free flaps are available for such reconstruction. This is a report of a case of locally aggressive infection that was initially confused as complex perianal fistula, then sarcoma after the initial resection. Surprisingly, the permanent pathology confirmed the diagnosis of a giant condyloma acuminatum extending to the anal area, for which an extensive wide local resection with margin and temporary colostomy was done, this resulted in a large defect necessitating a reconstruction with hybrid double apposing Superior gluteal artery perforator flap (SGAP flap) and Inferior gluteal artery perforator flap (IGAP flap) in Z-plasty fashion. That healed completely with no local complication. Chondyloma acuminatum is a benign but rare inflammatory disease Its treated as a local malignant condition Preserving the anal anatomy and function is crucial Combining local perforator flaps in the defect provide excellent option SGAP, IGAP is useful local option
Collapse
|
16
|
Tahamtan M, Ghahramani L, Khazraei H, Tabar YT, Bananzadeh A, Hosseini SV, Izadpanah A, Hajihosseini F. Surgical management of anal stenosis: anoplasty with or without sphincterotomy. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2016.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Aim Anal stenosis is an uncommon complication of anorectal surgery, mostly resulting from circumferential hemorrhoidectomy or resection of the skin tag in surgical management of chronic anal fissure. The aim of anoplasty is to restore normal function to the anus by dividing the stricture and widening the anal canal. Internal sphincterotomy may cause gas incontinence and if we manage the stenosis without sphincterotomy it could be failed. Could we use anoplasty without sphincterotomy?
Method The patients with anal stenosis were assigned in to two groups. The first group underwent Y-V anoplasty without partial lateral internal sphinctrotomy and the second one underwent Y-V anoplasty with partial lateral internal sphinctrotomy.
Result A total of 25 patients (10 male and 15 female) underwent anoplasty, 14 without partial lateral internal sphincterotomy and 11 patients with partial lateral internal sphincterotomy. The healing rate of stenosis was 91% and 93% in groups undergoing anoplasty without partial lateral internal sphinctrotomy and anoplasty with partial lateral internal sphictrotomy, respectively (p value 0.69). There was no significant change in both groups for post-operative incontinence complaints.
Conclusion The healing rate of anal stenosis was the same in the patients who underwent Y-V anoplasty with or without partial lateral internal sphinctrotomy. There was no significant change in post-operation incontinence between the two groups. Therefore, Y-V anoplasty would be a safe and simple surgical method in selected patients. Partial lateral internal sphinctrotomy procedure has been noticed in individual cases.
Collapse
Affiliation(s)
- Mehdi Tahamtan
- Shiraz University of Medical Sciences, Colorectal Research Center, Shiraz, Iran
| | - Leila Ghahramani
- Shiraz University of Medical Sciences, Colorectal Research Center, Shiraz, Iran
| | - Hajar Khazraei
- Shiraz University of Medical Sciences, Colorectal Research Center, Shiraz, Iran
| | - Yaser Tolouei Tabar
- Shiraz University of Medical Sciences, Colorectal Research Center, Shiraz, Iran
| | | | | | - Ahmad Izadpanah
- Shiraz University of Medical Sciences, Colorectal Research Center, Shiraz, Iran
| | - Fahime Hajihosseini
- Shiraz University of Medical Sciences, Colorectal Research Center, Shiraz, Iran
| |
Collapse
|
17
|
A novel four quadrant laser sphincterotomy for idiopathic severe anal stenosis. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2017.09.419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AbstractAnal stricture or stenosis, though uncommon, is disabling condition. It affects the quality of life due to pain, bleeding and difficulty in defecation, incontinence or increased frequency. It occurs when the normally pliable anoderm is replaced with fibrotic connective tissue, leading to an abnormally tight and inelastic anal canal. Mostly it occurs secondary to trauma, iatrogeny, inflammatory diseases, radiation or neoplasia. The treatment of anal stricture is generally considered to be difficult and various methods of treatment have been suggested. It is often unresponsive to conservative medical management. The surgical procedures such as dilatations and anoplasty are associated with significant complications which make it a difficult treatment challenge. Several good treatment options are available currently. Through this case, we report and explore a new medical treatment for anal strictures with four quadrant laser sphincterotomy.
Collapse
|
18
|
Luo S, Zhang X, Hou Y, Hu H, Dong J, Wang L, Kang L. Transanal and transabdominal combined endoscopic resection of rectal stenosis and anal reconstruction based on transanal endoscopic technique. Surg Endosc 2021; 35:6827-6835. [PMID: 33398554 DOI: 10.1007/s00464-020-08188-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To propose a method for the resection of the rectal anastomotic stenosis and anal reconstruction based on the transanal endoscopic technique through a transanal and transabdominal combined endoscopic resection, and to verify its clinical effectiveness. METHODS Thirty-eight patients with anastomotic stenosis were admitted to the Sixth Affiliated Hospital, Sun Yat-sen University, China, from January 2016 to September 2019. Patients were divided into an experimental group (17 patients) and a control group (21 patients) subjected to the removal of the intestinal stenosis followed by anal reconstruction, they underwent transanal and transabdominal endoscopic surgery and traditional transabdominal surgery, respectively. Data on intraoperative blood loss, operation time, postoperative recovery, and prognosis were collected. RESULTS (1) The median intraoperative blood loss was approximately 100 ml, without conversion to laparotomy during the surgery and intraoperative complications. The safety of the surgical operation was improved. (2) The operation time was shortened compared to previous reports, and the median operative time was 193 min. The average time of transanal endoscopic dissociation to the retroperitoneal fold was 76 min. (3) Laparoscopic assistance was carried out on 14 of the17 patients, and the incision was reduced. (4) The short-term curative effect was quite satisfactory, without permanent stoma. The average time to recover food intake after the surgery was 1.5 days. The average ambulation time was 3 days. Within 30 days after the surgery, one case suffered anastomotic leakage and then underwent refunctioning stoma through a second surgery. One patient suffered from intestinal obstruction, and the condition was improved through a conservative treatment. One case experienced delayed abdominal wound healing. CONCLUSION The transanal and transabdominal endoscopic resection of the rectal anastomotic stenosis and anal reconstruction reduced the difficulty of the surgery, improved its safety, shortened the operation time, decreased the operative complications, and enabled patients to recover well after surgery.
Collapse
Affiliation(s)
- Shuangling Luo
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, China.,Guangdong Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, Guangdong, China
| | - Xingwei Zhang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, China.,Guangdong Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, Guangdong, China
| | - Yujie Hou
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, China.,Guangdong Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, Guangdong, China
| | - Huanxin Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, China.,Guangdong Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, Guangdong, China
| | - Jianghui Dong
- UniSA Clinical & Health Sciences, and UniSA Cancer Research Institute, University of South Australa, Adelaide, SA, 5001, Australia
| | - Liping Wang
- UniSA Clinical & Health Sciences, and UniSA Cancer Research Institute, University of South Australa, Adelaide, SA, 5001, Australia.
| | - Liang Kang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, China. .,Guangdong Institute of Gastroenterology, and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, Guangdong, China.
| |
Collapse
|
19
|
Lane VA, Calisto J, deBlaauw I, Calkins CM, Samuk I, Avansino JR. Assessing the previously repaired patient with an anorectal malformation who is not doing well. Semin Pediatr Surg 2020; 29:150995. [PMID: 33288142 DOI: 10.1016/j.sempedsurg.2020.150995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this review, the care of children with a previously repaired anorectal malformation is explored. We know that the surgical care of children with anorectal malformations is complex; however, despite an increased understanding of the congenital anomaly and significant technical advances in the operative repair, many of these children continue to have poor functional outcomes. In this article we focus on the common surgical complications, discuss typical presentations, consider appropriate investigations, and review the risks and benefits of revisional surgery in those patients that are 'not doing well' following their primary reconstruction.
Collapse
Affiliation(s)
- Victoria A Lane
- Department of Paediatric Surgery, Great North Children's Hospital, Newcastle-Upon-Tyne, UK.
| | - Juan Calisto
- Colorectal Center, Nicklaus Children's Hospital, Miami, FL, USA
| | - Ivo deBlaauw
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Casey M Calkins
- The Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Inbal Samuk
- Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Jeffrey R Avansino
- Reconstructive Pelvic Medicine Program, Seattle Children's Hospital, Seattle, WA, USA; Department of Surgery, University of Washington, USA
| |
Collapse
|
20
|
Gallo G, Stratta E, Realis Luc A, Clerico G, Trompetto M. A tailored rhomboid advancement flap for severe anal stenosis - a video vignette. Colorectal Dis 2020; 22:1776-1777. [PMID: 32502308 DOI: 10.1111/codi.15178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/19/2020] [Indexed: 02/08/2023]
Affiliation(s)
- G Gallo
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - E Stratta
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.,Department of Surgery, University of Genoa, Genoa, Italy
| | - A Realis Luc
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| |
Collapse
|
21
|
Gallo G, Stratta E, Realis Luc A, Clerico G, Trompetto M. A tailored rhomboid mucocutaneous advancement flap to treat anal stenosis. Colorectal Dis 2020; 22:1388-1395. [PMID: 32401371 DOI: 10.1111/codi.15118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/18/2020] [Indexed: 02/08/2023]
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 ± 48.3 (33-180) months. The main aetiology was a previous excisional haemorrhoidectomy (N = 23; 46%). The mean preoperative anal calibre was 9.96 ± 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 ± 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.
Collapse
Affiliation(s)
- G Gallo
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - E Stratta
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.,Department of Surgery, University of Genoa, Genoa, Italy
| | - A Realis Luc
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| |
Collapse
|
22
|
Klimasauskiene V, Dulskas A, Samalavicius NE. House advancement flap anoplasty for severe post-haemorrhoidectomy anal stenosis - a video vignette. Colorectal Dis 2020; 22:1207-1208. [PMID: 32270585 DOI: 10.1111/codi.15059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/21/2020] [Indexed: 12/29/2022]
Affiliation(s)
- V Klimasauskiene
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
| | - A Dulskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Faculty of Health Care, University of Applied Sciences, Vilnius, Lithuania
| | - N E Samalavicius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.,Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
23
|
Latest Advances in Intersphincteric Resection for Low Rectal Cancer. Gastroenterol Res Pract 2020; 2020:8928109. [PMID: 32765603 PMCID: PMC7387965 DOI: 10.1155/2020/8928109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background Intersphincteric resection (ISR) has been a preferable alternative to abdominoperineal resection (APR) for anal preservation in patients with low rectal cancer. Laparoscopic ISR and robotic ISR have been widely used with the proposal of 2 cm or even 1 cm rule of distal free margin and the development of minimally invasive technology. The aim of this review was to describe the newest advancements of ISR. Methods A comprehensive literature review was performed to identify studies on ISR techniques, preoperative chemoradiotherapy (PCRT), complications, oncological outcomes, and functional outcomes and thereby to summarize relevant information and controversies involved in ISR. Results Although PCRT is employed to avoid positive circumferential resection margin (CRM) and decrease local recurrence, it tends to engender damage of anorectal function and patients' quality of life (QoL). Common complications after ISR include anastomotic leakage (AL), anastomotic stricture (AS), urinary retention, fistula, pelvic sepsis, and prolapse. CRM involvement is the most important predictor for local recurrence. Preoperative assessment and particularly rectal endosonography are essential for selecting suitable patients. Anal dysfunction is associated with age, PCRT, location and growth of anastomotic stoma, tumour stage, and resection of internal sphincter. Conclusions The ISR technique seems feasible for selected patients with low rectal cancer. However, the postoperative QoL as a result of functional disorder should be fully discussed with patients before surgery.
Collapse
|
24
|
Hancke E. Sphinkterschonende operative Therapie der chronischen Analfissur durch primäre plastische Deckung. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
25
|
Hancke E, Suchan K, Völke K. Anokutaner Advancement-Flap zur sphinkterschonenden chirurgischen Therapie der chronischen Analfissur. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00449-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
26
|
Warsinggih, Dani MI, Kusuma MI, Labeda I, Uwuratuw JA, Faruk M. Repair of anal stenosis using a prolapse and hemorrhoids (PPH) stapler procedure: A case report with excellent results. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
27
|
Ghorbanpour M, Seyfrabie MA, Yousefi B. Early and long-term complications following transanal pull through Soave technique in infants with Hirschsprung's disease. Med Pharm Rep 2019; 92:382-386. [PMID: 31750439 PMCID: PMC6853039 DOI: 10.15386/mpr-1314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/21/2019] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background and aim Patients undergoing Soave surgery for Hirschsprung’s disease are at risk for some complications. The aim of this study was to investigate such short-term and long-term complications and evaluate the outcome of the operation in these patients. Methods A case series study was carried out during the last 12 years, during 2007 to 2018 in Besat hospital of Hamadan. Data collection conducted using a checklist includes questions about demographic information, clinical features, and short-term and long-term complications, and consequences of post-operative surgery. The findings of the study were analyzed using SPSS software version 20 and appropriate statistical tests. P-value less than 0.05 was considered statistically significant. Results A total of 55 children underwent Soave surgery during the last 12 years in Besat Hospital Hamadan, Iran. The mean age of the patients was 38±10 days during surgery, of which 56.4% were female. The mean hospital stay was 7.3 days. Also, the mean weight of children at birth was 2970±447 gr. Most of the patients were born as NVD (52.7%) and term (74.5%). The most common comorbidity was congenital heart disease. The most common short-term complication was intestinal obstruction in 14 patients (25.5%) and the most frequent long-term complication was intestinal obstruction and constipation (27.3% each cases). The mortality rate of patients in this study was 14.5% in total. Conclusions One stage surgical procedure in Hirschsprung’s disease is a safe and effective method, but care should be taken in choosing patients and patients should be monitored for possible complications, so that they can be considered and implemented for proper treatment
Collapse
Affiliation(s)
- Manoochehr Ghorbanpour
- Department of Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Mohammad Ali Seyfrabie
- Department of Social Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| | - Babak Yousefi
- Department of Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, IR Iran
| |
Collapse
|
28
|
Jumbi T, Kuria K, Osawa F, Shahbal S. The effectiveness of digital anal dilatation in preventing anal strictures after anorectal malformation repair. J Pediatr Surg 2019; 54:2178-2181. [PMID: 31053362 DOI: 10.1016/j.jpedsurg.2019.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/07/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Anal dilatation is performed after repair of anorectal malformations(ARMs) and is vital in prevention of anal stricture formation. The ideal protocol utilizes Hegar dilators. In our setup, few parents will acquire Hegar dilators for home based anal dilatation but majority will use fingers as an alternative. The basis of this study was to determine the effectiveness of digital anal dilatations in preventing anal strictures. MATERIALS AND METHODS This was a descriptive cross-sectional study carried out at Kenyatta National Hospital (KNH) which recruited children post ARM repair undergoing digital anal dilatation. The diameters of the digits used for anal dilatation were assessed for adequacy using the desired anal size as a reference point. The main outcome variable was the presence of anal strictures. Data were entered in a data collection sheet and analyzed by use of SPSS (V.21.0 Chicago, Illinois). Chi-square test and Fisher's exact test were used to ascertain association among variables. A P-value of less than 0.05 was considered statistically significant. RESULTS 50 patients with ARM post repair were recruited in the study. The rate of occurrence of anal stricture was 22%. Among the participants with anal strictures, only 27% were compliant to the dilatation regimen while 73% reported noncompliance. The mean diameter(mm) of the dilating digits at the level of the middle phalanx was Index finger (15.4 ± 0.58), middle finger (15.2 ± 0.61), ring finger (14.2 ± 0.71), small finger (12.5 ± 0.91) and thumb (17.6 ± 0.78). 46% of the participants were dilated with appropriately sized digits. The remainder had dilatations done with larger (22%) or smaller digits (32%). Notably, anal strictures occurred in participants who were dilated with inappropriately sized digits (P = 0.001). CONCLUSION Digital anal dilatation is safe and effective as a mode of anal dilation in the setting of compliance to a strict dilatation protocol, daily frequency of dilations and use of appropriately sized digits. Owing to the variability in the finger size, we recommend that digits be calibrated and education given to the caregivers on the use of the appropriately sized digit. LEVEL OF EVIDENCE Treatment study. Level III.
Collapse
Affiliation(s)
- Timothy Jumbi
- Department of Surgery, University of Nairobi, Nairobi, Kenya.
| | - Kihiko Kuria
- Department of Surgery, University of Nairobi, Nairobi, Kenya.
| | - Francis Osawa
- Department of Surgery, University of Nairobi, Nairobi, Kenya.
| | - Swaleh Shahbal
- Department of Surgery, University of Nairobi, Nairobi, Kenya.
| |
Collapse
|
29
|
Handaya Y, Sunardi M. Bilateral Rotational S Flap Technique for Preventing Restenosis in Patients With Severe Circular Anal Stenosis: A Review of 2 Cases. Ann Coloproctol 2019:221-224. [PMID: 30781931 PMCID: PMC6732331 DOI: 10.3393/ac.2017.10.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/16/2017] [Indexed: 12/21/2022] Open
Abstract
Anal stenosis is a late hemorrhoidectomy complication. Sphincterotomy and various anoplasty techniques are used for treatment severe anal stenosis, such as the C flap, House flap, U flap, and rotational S flap, but no procedure is ideal for every patient. We review 2 cases of severe circular anal stenosis. Their complaints included narrow caliber of the stool and feeling unsatisfied defecation. Excision of scar tissue using the circular technique was followed by reconstruction using the bilateral rotational S flap procedure. At the 1-year follow-up, the patient had complaints about neither defecation nor pain, and no longer needed laxative agents. In conclusion, the bilateral rotational S flap technique should be considered as a viable treatment because it can also prevent the occurrence of restenosis, especially given the consideration of adequate blood supply.
Collapse
Affiliation(s)
- Yuda Handaya
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Mukhamad Sunardi
- Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| |
Collapse
|
30
|
Halleran DR, Sanchez AV, Rentea RM, Ahmad H, Weaver L, Reck C, Gasior AC, Levitt MA, Wood RJ. Assessment of the Heineke-Mikulicz anoplasty for skin level postoperative anal strictures and congenital anal stenosis. J Pediatr Surg 2019; 54:118-122. [PMID: 30366721 DOI: 10.1016/j.jpedsurg.2018.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Acquired skin-level strictures following posterior sagittal anorectoplasty (PSARP) and some rare cases of congenital anal stenosis can be managed using a Heineke-Mikulicz like anoplasty (HMA). We hypothesized that this procedure was an effective, safe, and durable outpatient procedure in select patients. METHODS We retrospectively reviewed all patients who underwent HMA for skin level strictures following PSARP or for certain congenital anal stenoses from 2014 to 2017. RESULTS Twenty-eight patients (19 males, 9 females) with a mean age of 5.8 years (range 0.5-24.4) underwent HMA. Twenty-six had a prior PSARP, of which 18 were redo, and 8 were primary procedures. Two patients had congenital skin level anal stenosis. The mean follow up was 1.0 years (range 0.4-2.9). The average preprocedure anal size was Hegar 8, which after HMA increased 8 Hegar sizes to 16 (95% CI 7-9, p < 0.001). There were no operative complications. One patient restenosed and required a secondary procedure. CONCLUSION HMA is a safe procedure for skin-level anal strictures following PSARP (primary and redo) and can also be used in some rare cases of congenital anal stenosis. Long-term follow up to determine the restricture rate is ongoing. A plan to do an HMA if a stricture develops may offer an alternative to routine anal dilations, particularly after a redo PSARP in an older child. TYPE OF STUDY Case series. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Devin R Halleran
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH.
| | | | - Rebecca M Rentea
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Hira Ahmad
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Carlos Reck
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Alessandra C Gasior
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
31
|
Wang WG, Lu WZ, Yang CM, Yu KQ, He HB. Effect of lateral internal sphincterotomy in patients undergoing excisional hemorrhoidectomy. Medicine (Baltimore) 2018; 97:e11820. [PMID: 30095654 PMCID: PMC6133531 DOI: 10.1097/md.0000000000011820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Excisional hemorrhoidectomy (EH) is the major surgical option for high-grade symptomatic hemorrhoids, but it has some shortcomings, especially postoperative pain. This study was performed to assess the effect of lateral internal sphincterotomy (LIS) in patients undergoing excisional hemorrhoidectomy. METHODS A systematic literature search (Medline, Embase, Cochrane Library, Science Citation Index, Science Direct, Springer Link, Ovid Journals, and EBSCO) was performed to identify all eligible articles. Randomized controlled trials (RCTs) published until July 7, 2017 comparing EH combined with LIS (experimental group) with EH only (control group) were eligible for inclusion. The primary outcome of interest was postoperative pain. RESULTS Ten RCTs involving 1560 patients were identified for inclusion. The pooled analysis revealed that patients undergoing EH and LIS were associated with lower pain score [standardized mean difference (SMD), -0.75; 95% confidence interval (CI), -1.14 to -0.36; z = 3.76; P = .0002] and resting anal pressure [odds ratio (OR), -17.19; 95% CI, -25.66 to -8.72; z = 3.98; P < .0001], and lower incidence of anal stricture (OR, 0.12; 95% CI, 0.03-0.53; z = 2.85; P = .004). However, the differences of urinary retention, bleeding and length of hospital stay were similar between the 2 methods. CONCLUSION Our meta-analysis suggests that LIS effectively relieves postoperative pain and reduces patient's postoperative analgesic requirements. LIS also reduces the incidence of anal stenosis but increases the incidence of fecal incontinence.
Collapse
Affiliation(s)
- Wei-Guo Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University
| | - Wen-Zhu Lu
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University
| | - Chun-Mei Yang
- Department of Integrated Traditional Chinese and Western Medicine, Cheng Du Shang Jin Nan Fu Hospital, Chengdu, Sichuan Province, China
| | - Ke-Qiang Yu
- Department of Integrated Traditional Chinese and Western Medicine, Cheng Du Shang Jin Nan Fu Hospital, Chengdu, Sichuan Province, China
| | - Hong-Bo He
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University
| |
Collapse
|
32
|
Abstract
BACKGROUND Post-hemorrhoidectomy anal stenosis though rare is very disturbing and devastating complication. Many surgical procedures have been described, but despite good results, many complications can ensue like flap necrosis, mucosal ectropion, and restenosis. OBJECTIVE We report a new simple technique for repair of severe/moderate anal stenosis which requires no extensive flap mobilization or many sutures. PATIENTS AND INTERVENTIONS This is a personal series of 65 patients treated over a period of 20 years. The data were prospectively recorded by the author. The essence of this simple procedure is mobilizing the anal mucosa to the dentate line via a vertical incision and mobilizing the adjacent perianal skin and subcutaneous fat to allow a completely tension-free approximation of the perianal skin and the anal mucosa which are sutured together transversely. A tension-releasing incision is made in the perianal region which is left to heal by secondary intention. RESULTS Fifty-nine patients (90.8%) continued the 5-year follow-up, and 6 patients left the country after 2 years of follow-up. There was only one case of recurrence after 2 years, which was treated by a second anoplasty. Four patients (59-66 years old) developed transient urine retention after surgery. One patient developed partial dehiscence of the suture line which was treated conservatively. No mucosal ectropion or perianal skin necrosis was observed. Complete healing of the perianal tension-releasing wound was within 2-3 months. By the third week after surgery, all the patients discontinued use of stool softeners or laxatives and were able to defecate comfortably. CONCLUSIONS This procedure is simple and requires little dissection and only a few sutures with minimal complications. It is suitable for low severe and moderate anal stenosis.
Collapse
Affiliation(s)
- Sami Asfar
- Department of Surgery, Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110, Safat, Kuwait.
| |
Collapse
|
33
|
Aghayeva A, Atasoy D, Bayraktar O, Cengiz TB, Baghaki S, Baca B, Hamzaoglu I, Karahasanoglu T. V-Y advancement flap reconstruction for anal stricture - a video vignette. Colorectal Dis 2018; 20:78-79. [PMID: 29053211 DOI: 10.1111/codi.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/14/2017] [Indexed: 02/08/2023]
Affiliation(s)
- A Aghayeva
- Özel Acıbadem Atakent Hastanesi, Istanbul, Turkey
- Department of Surgery, Acibadem University School of Medicine, Atakent Hospital, Istanbul, Turkey
| | - D Atasoy
- Özel Acıbadem Atakent Hastanesi, Istanbul, Turkey
- Department of Surgery, Acibadem University School of Medicine, Atakent Hospital, Istanbul, Turkey
| | - O Bayraktar
- Özel Acıbadem Atakent Hastanesi, Istanbul, Turkey
- Department of Surgery, Acibadem University School of Medicine, Atakent Hospital, Istanbul, Turkey
| | - T B Cengiz
- Acibadem University School of Medicine, Istanbul, Turkey
| | - S Baghaki
- Department of Plastic and Reconstructive Surgery, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - B Baca
- Özel Acıbadem Atakent Hastanesi, Istanbul, Turkey
- Department of Surgery, Acibadem University School of Medicine, Atakent Hospital, Istanbul, Turkey
| | - I Hamzaoglu
- Department of Surgery, Acibadem University School of Medicine, Maslak Hospital, Istanbul, Turkey
| | - T Karahasanoglu
- Department of Surgery, Acibadem University School of Medicine, Maslak Hospital, Istanbul, Turkey
| |
Collapse
|
34
|
Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer. Surg Endosc 2017; 32:660-666. [PMID: 28726144 DOI: 10.1007/s00464-017-5718-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/10/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Anastomotic stricture following colorectal cancer surgery is not a rare complication, but proper management of anastomotic stricture located close to the anal verge is uncertain. This study aimed to investigate risk factors and management strategies for anastomotic stricture after ultralow anterior resection (ULAR). METHODS We retrospectively reviewed a database of patients with rectal cancer who underwent surgery between January 2007 and June 2015, and included patients with an anastomosis within 4 cm from the anal verge. Clinical outcomes and risk factors for anastomotic stricture were investigated. RESULTS Among the 586 patients included, 46 (7.8%) were diagnosed as having anastomotic stricture. Multivariable logistic regression analysis revealed that intersphincteric resection (ISR) with hand-sewn anastomosis (odds ratio [OR] = 3.070; 95% confidence interval [CI] 1.247-7.557) and postoperative radiotherapy (OR 6.237; 95% CI 1.961-19.841) were independent risk factors of anastomotic stricture. Forty-one (89.1%) underwent anastomotic dilatation with a Hegar dilator; while three patients (6.5%) underwent endoscopic balloon dilatation and two (4.3%) underwent surgery initially. Among the patients with initial nonoperative management (n = 44), 21 (47.7%) were completely cured with nonoperative management alone, 12 (27.3%) experienced complications, such as bowel perforation, anastomotic rupture, and perirectal abscess; and 21 (47.7%) underwent further surgical management. Fifteen patients (32.6%) eventually had permanent stoma. CONCLUSION ISR with a hand-sewn coloanal anastomosis, compared to ULAR with double-stapling anastomosis, and postoperative radiotherapy were independent risk factors of anastomotic stricture after surgery for very low-lying rectal cancer. Nonoperative anastomotic dilatation showed poor clinical outcome, with high complication rates, and subsequent surgical management. Therefore, nonoperative management of such patients should be carefully selected.
Collapse
|
35
|
Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier's Gangrene. Case Rep Surg 2017; 2017:2062157. [PMID: 28255493 PMCID: PMC5306967 DOI: 10.1155/2017/2062157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/05/2017] [Indexed: 11/20/2022] Open
Abstract
Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier's gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure.
Collapse
|
36
|
Jeong H, Hwang S, Ryu KO, Lim J, Kim HT, Yu HM, Yoon J, Lee JY, Kim HR, Choi YG. Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III-IV Prolapsing Hemorrhoids. Ann Coloproctol 2017; 33:28-34. [PMID: 28289661 PMCID: PMC5346778 DOI: 10.3393/ac.2017.33.1.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/02/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III-IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH. METHODS We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler. RESULTS Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur. CONCLUSION PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III-IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids.
Collapse
Affiliation(s)
| | - Sunghwan Hwang
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Kil O Ryu
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Jiyong Lim
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Hyun Tae Kim
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Hye Mi Yu
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Jihoon Yoon
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Ju-Young Lee
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Hyoung Rae Kim
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Young Gil Choi
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| |
Collapse
|
37
|
Indications and Technical Aspects of Internal Anal Sphincterotomy: Highlighting the Controversies. Dis Colon Rectum 2017; 60:128-132. [PMID: 27926567 DOI: 10.1097/dcr.0000000000000724] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
38
|
Rhomboid-shaped advancement flap anoplasty to treat anal stenosis. Tech Coloproctol 2016; 21:159-161. [PMID: 27942963 DOI: 10.1007/s10151-016-1560-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 11/09/2016] [Indexed: 12/11/2022]
|
39
|
Lawal TA, Reck CA, Wood RJ, Lane VA, Gasior A, Levitt MA. Use of a Heineke-Mikulicz like stricturoplasty for intractable skin level anal strictures following anoplasty in children with anorectal malformations. J Pediatr Surg 2016; 51:1743-5. [PMID: 27516175 DOI: 10.1016/j.jpedsurg.2016.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/06/2016] [Accepted: 07/15/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We introduced a modification of the Heineke-Mikulicz technique to treat intractable skin level anal strictures post posterior sagittal anorectoplasty (PSARP). The aim of this article is to describe the technique and outcome in a series of patients. METHODS This was a retrospective evaluation of patients who had Heineke-Mikulicz like stricturoplasty performed for a post PSARP skin level stricture over a one-year period. RESULTS Five patients who were operated using the technique were reviewed. All had severe anal strictures that could admit Hegar dilator sizes 6 to 9 at 16months to 5years after PSARP. All underwent routine dilatations, which became increasingly painful. As an alternative to continued dilatations, an operative procedure was offered. The surgery was done as a day case and lasted 10 to 30min. The anus at the end of the procedure could comfortably accept a Hegar dilator size 14 to 17. None of the patients had a colostomy after the procedure and there were no complications. CONCLUSIONS The Heineke-Mikulicz like stricturoplasty is a simple surgical procedure that can be done in an ambulatory setting to treat children with intractable skin level anal stricture if this develops following definitive surgery for anorectal malformations.
Collapse
Affiliation(s)
- Taiwo A Lawal
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Carlos A Reck
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Victoria A Lane
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alessandra Gasior
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
40
|
Abstract
BACKGROUND Hemorrhoid operations are performed frequently in Germany. After the operation severe complications can occur that require appropriate management. OBJECTIVE Presentation of current complications and suitable therapeutic options. MATERIAL AND METHODS Data including operative procedures and complications that have been collected in an electronic online-based survey of all resident, affiliated and private practice German surgeons during the period from 1 December 2009 to 31 January 2010 are presented. A review of the current literature in a PubMed search is given. RESULTS Stapled hemorrhoidopexy has several benefits during the early postoperative phase in comparison to conventional hemorrhoidectomy; however, patients should be informed about the possibility of postoperative defecation disorders, elevated recurrence and reoperation rates and rare life-threatening complications. CONCLUSION The aim should be to keep risks at a low level by means of prevention, patient selection, careful analysis of indications and relevant expertise. In cases of complications early recognition and direct initiation of adequate treatment are crucial.
Collapse
|
41
|
Li YF, Wang XF, Li HS. Diagnosis and treatment of iatrogenic anorectal stenosis. Shijie Huaren Xiaohua Zazhi 2016; 24:1632-1638. [DOI: 10.11569/wcjd.v24.i11.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Iatrogenic anorectal stenosis is one of serious complications after anorectal surgery, and it is often caused by improper operation in surgical resection of hemorrhoids and anal fistula, procedure for prolapse and hemorrhoids (PPH), internal hemorrhoid agent injection and saving anal sphincter in low rectal cancer. Because of the difficulty of defecation, severe anal pain may occur. Stenotic ring can be directly touched in anal and low rectal stenosis. The degree and extent of the stenosis can be observed by colonoscopy in upper rectal stenosis. Mild stenosis can be temporarily treated with conservative therapy. If the degree of stenosis does not relieve or stenosis is more severe, we can choose different types of surgery according to the position, scope and the reasons of stenosis, which include scar closed procedure, longitudinal incision and transverse suture procedure, thread-drawing procedure, reconstruction of the anus by skin flap transposition or colostomy. Although only one procedure was adopted in the majority of cases, two or more procedures can be combined. This article reviews the diagnosis and treatment of anorectal stenosis.
Collapse
|
42
|
Abstract
BACKGROUND Regarding anoplasty for anal stenosis, it is not clear to what extent the final anal caliber should be targeted. OBJECTIVE The aim of this study was to investigate the results of diamond-flap anoplasty performed in a calibrated manner for the treatment of severe anal stenosis due to a previous hemorrhoidectomy. DESIGN AND SETTING Prospectively prepared standard forms were evaluated retrospectively. PATIENTS AND INTERVENTIONS Anoplasty with unilateral or bilateral diamond flaps was performed for moderate or severe anal stenosis, targeting a final anal caliber of 25 to 26 mm. The demographic characteristics, causes of anal stenosis, number of previous surgeries, anal stenosis staging (Milsom and Mazier), anal calibers (millimeter), the Cleveland Clinic Incontinence Score, and the modified obstructed defecation syndrome Longo score were recorded on pre-prepared standard forms, as well as postoperative complications and the time of return to work. RESULTS From January 2011 to July 2013, 18 patients (12 males, 67%) with a median age of 39 years (range, 27-70) were treated. All of the patients had a history of previous hemorrhoidectomy. The number of previous corrective interventions was 2.1 ± 1.8 (range, 0-4), and 2 patients had a history of failed anoplasty. Five patients (28%) had moderate anal stenosis and 13 (72%) had severe anal stenosis. Preoperative, intraoperative, and 12-month postoperative anal calibration values were 9 ± 3 mm (range, 5-15), 25 ± 0.75 mm (range, 24-26), and 25 ± 1 mm (range, 23-27) (p < 0.0001, for immediate postoperative and 12-month postoperative anal calibers compared with the intraoperative). Preoperative and 12-month postoperative Cleveland Clinic Incontinence Scores were 0.83 ± 1.15 (range, 0-4) and 0.39 ± 0.70 (range, 0-2) (p = 1.0). The clinical success rate was 88.9%. No severe postoperative complications were observed. LIMITATIONS This study was limited because it was a single-armed, retrospective analysis of prospectively designed data. CONCLUSION Diamond-flap anoplasty performed in a standardized and calibrated manner is a highly successful method for the treatment of anal stenosis caused by previous hemorrhoidectomy.
Collapse
|
43
|
Abstract
Anorectal surgery is well tolerated. Rates of minor complications are relatively high, but major postoperative complications are uncommon. Prompt identification of postoperative complications is necessary to avoid significant patient morbidity. The most common acute complications include bleeding, infection, and urinary retention. Pelvic sepsis, while may result in dramatic morbidity and even mortality, is relatively rare. The most feared long-term complications include fecal incontinence, anal stenosis, and chronic pelvic pain.
Collapse
Affiliation(s)
- Hiroko Kunitake
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Vitaliy Poylin
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
44
|
Chronic severe constipation: current pathophysiological aspects, new diagnostic approaches, and therapeutic options. Eur J Gastroenterol Hepatol 2015; 27:204-14. [PMID: 25629565 DOI: 10.1097/meg.0000000000000288] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic constipation is a considerable problem because it significantly affects the quality of a patient's life. Constipation can be diagnosed at every age and is more frequent in women and among the elderly. In epidemiological studies, its incidence is estimated at 2-27% in the general population. Chronic constipation may be primary or secondary. However, primary constipation (functional or idiopathic) can be classified into normal transit constipation, slow transit constipation, and pelvic outlet obstruction. In this review we make an attempt to present the current pathophysiological aspects and new therapeutic options for chronic idiopathic constipation, particularly highlighting the value of patient assessment for accurate diagnosis of the cause of the problem, thus helping in the choice of appropriate treatment.
Collapse
|
45
|
Qarabaki MA, Mukhashavria GA, Mukhashavria GG, Giorgadze NG. Circular vs. three-quadrant hemorrhoidectomy for end-stage hemorrhoids: short- and long-term outcomes of a prospective randomized trial. J Gastrointest Surg 2014; 18:808-15. [PMID: 24297654 DOI: 10.1007/s11605-013-2424-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 11/18/2013] [Indexed: 01/31/2023]
Abstract
PURPOSE Circumferential excisional hemorrhoidectomy (CEH) enables the surgeon to remove the encircling hemorrhoids completely. The purpose of this study is to compare the efficacy of CEH with that of Ferguson hemorrhoidectomy (FH) for end-stage hemorrhoids. METHODS Between February 1998 and December 2011, a prospective randomized trial was conducted with 688 patients who presented with end-stage hemorrhoids and underwent FH or CEH at our center. RESULTS The patient demographics, mean operative times, lengths of hospital stay, and cumulative rates of postoperative complications were similar in the study groups. Significant differences were revealed in the incidence of postoperative hemorrhage (9 vs. 0 patients in the FH and CEH groups, respectively; p = 0.002) and in the tendency to form anal stricture (15 vs. 32 patients in the FH and CEH groups, respectively; p = 0.02). However, all cases of anal strictures were easily managed by digital dilatations. At a mean follow-up of 7.4 (range, 1-14) years, accessible patients from the CEH group remained symptom free, whereas 126 of 308 patients in the FH group indicated that they had recurrent hemorrhoidal symptoms. CONCLUSION Without increasing postoperative complications, CEH demonstrates an advantage compared with FH, with regard to reducing the rate of recurrence to 0 through complete hemorrhoid removal.
Collapse
|
46
|
Abstract
Anal fissure is a common anorectal disorder resulting in anal pain and bleeding. Fissures can either heal spontaneously and be classified as acute, or persist for 6 or more weeks and be classified as chronic, ultimately necessitating treatment. Anal stenosis is a challenging problem most commonly resulting from trauma, such as excisional hemorrhoidectomy. This frustrating issue for the patient is equally as challenging to the surgeon. This article reviews these 2 anorectal disorders, covering their etiology, mechanism of disease, diagnosis, and algorithm of management.
Collapse
Affiliation(s)
- Sherief Shawki
- Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | |
Collapse
|
47
|
Abstract
We describe a technique for the management of prolapsing hemorrhoids, with the aim to minimize the risk of anal stricture and rectovaginal fistula and to reduce the impact of the stapling technique on rectal compliance. This modified procedure was successfully applied in China, and preliminary data showed promising outcomes (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A117).
Collapse
|
48
|
Kołodziejczak M, Santoro GA, Słapa RZ, Szopiński T, Sudoł-Szopińska I. Usefulness of 3D transperineal ultrasound in severe stenosis of the anal canal: preliminary experience in four cases. Tech Coloproctol 2013; 18:495-501. [PMID: 24081548 PMCID: PMC3996354 DOI: 10.1007/s10151-013-1078-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 09/17/2013] [Indexed: 12/25/2022]
Abstract
Background Organic or functional anal canal stenoses are uncommon conditions that occur in the majority of cases as a consequence of anal diseases. A proper assessment is fundamental for decision making; however, proctological examination and endoanal ultrasound are often unfeasible or very difficult to perform even under local or general anesthesia. We therefore began to use 3D transperineal ultrasound to assess patients. The aim of this study was to compare the results of evacuation proctography and 3D transperineal ultrasound in patients with severe anal canal stenosis. Methods Four consecutive patients with high-grade anal canal stenosis were evaluated using both proctography and 3D transperineal ultrasound with a micro-convex transducer between March and June 2011. Results In all cases, 3D transperineal ultrasound provided detailed information on the length and level of stenosis and on the integrity of the anal sphincters. Conclusions Our preliminary experience suggests that 3D transperineal ultrasound makes it possible to plan optimal surgical treatment.
Collapse
Affiliation(s)
- M Kołodziejczak
- Department of Proctology, Hospital at Solec, 00-382, Warsaw, Poland
| | | | | | | | | |
Collapse
|
49
|
Stadiengerechte Therapie des Hämorrhoidalleidens. COLOPROCTOLOGY 2013. [DOI: 10.1007/s00053-013-0368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
50
|
Suh YJ, Ha HK, Oh HK, Shin R, Jeong SY, Park KJ. Rectal perforation caused by anal stricture after hemorrhoid treatment. Ann Coloproctol 2013; 29:28-30. [PMID: 23586012 PMCID: PMC3624977 DOI: 10.3393/ac.2013.29.1.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022] Open
Abstract
Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5℃. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation.
Collapse
Affiliation(s)
- Yong Joon Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|