Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1007/DCR.0b013e3181d3205a
Original Contribution

Comparative Study of the House Advancement Flap, Rhomboid Flap, and Y-V Anoplasty in Treatment of Anal Stenosis: A Prospective Randomized Study

Farid, Mohamed M.D.; Youssef, Mohamed M.D.; El Nakeeb, Ayman M.D.; Fikry, Amir M.D.; El Awady, Saleh M.D.; Morshed, Mosaad M.D.

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PURPOSE: Anal stenosis represents a technical challenge for surgical management. We compared the effects of house flap, rhomboid flap, and Y-V anoplasty procedures in a randomized study in patients with anal stenosis.

METHODS: Consecutive patients treated for anal stenosis at our institution were evaluated for inclusion. Participants were randomly allocated to receive house flap, rhomboid flap, or Y-V anoplasty. Follow-up visits were after 1 week, 1 month, 6 months, and 1 year. Study variables included caliber of the anal canal (measured with a conical calibrator), clinical improvement, patient satisfaction (visual analog scale), incontinence (Pescatori incontinence scale), and quality of life (GI Quality of Life Inventory).

RESULTS: Sixty patients with anal stenosis were randomized and completed the study. Operative time was 62 ± 10 minutes for house flap, 44 ± 13 minutes for rhomboid flap, and 35 ± 9 minutes for Y-V anoplasty (P = .042). At 1 year, anal caliber was 23.9 ± 2.33 mm for house flap, 18.1 ± 2.05 mm for rhomboid flap, and 16.4 ± 2.05 mm for Y-V anoplasty (P = .04), with a highly significant increase for the house flap (P = .001). The groups differed significantly regarding clinical improvement at 1 month (95% for house flap, 80% for rhomboid flap, and 65% for Y-V anoplasty, P = .01) and differences persisted at 1 year. Significant differences were seen among groups at 1 year in GI Quality of Life Inventory scores (P = .03), with significant improvement only for the house flap (P = .01).

CONCLUSION: Anal stenosis can be effectively managed with the house flap procedure, with the sole disadvantage of longer operative time. Although all 3 procedures are simple and easy to perform, the house flap appears to produce the greatest clinical improvement, patient satisfaction, and improvement in quality of life, with the fewest complications.

© The ASCRS 2010


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