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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.

Diseases of the Colon & Rectum: May 2010 - Volume 53 - Issue 5 - p 790-797
doi: 10.1007/DCR.0b013e3181d3205a
Original Contribution

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.

Department of General Surgery, Colorectal Surgery Unit, Mansoura University, Mansoura, Egypt

Financial Disclosure: None reported.

Correspondence: Ayman El Nakeeb, M.D., Department of General Surgery, Dep. 8 and Colorectal Unit, Mansoura University, Mansoura 335111, Egypt. E-mail:

© The ASCRS 2010