Search

Lateral internal sphincterotomy (LIS) remains a standard for chronic anal fissure even though other surgical techniques have shown high efficacy. Faecal incontinence is a well-documented complication of LIS. We devised modified open posterior internal sphincterotomy (m-OPIS) with sliding skin graft (SSG), which is a combined procedure of OPIS and anal advancement flap. The aim of this study is to evaluate m-OPIS + SSG. This was a retrospective, observational, single-arm study. m-OPIS + SSG was performed for chronic anal fissure and anal stenosis. m-OPIS involved incision of the internal sphincter muscle at the posterior midline until four fingers could be passed. The incision wound was closed by anastomosis of the anoderm and skin. Then, an arcuate skin incision was created and the skin graft was advanced into the anal canal. Follow-up was conducted by clinical consultation and telephone interview. Faecal continence was assessed by Cleveland Clinic Faecal Incontinence (CCFI) score. m-OPIS + SSG was performed in 143 patients. The mean patient age was 50 ± 16 years. The success and overall recurrence rates after m-OPIS + SSG were 99% and 0.7%, respectively, with a median follow-up period of 16.3 years. One patient developed incontinence with liquid stools once during the 6-month period. None of the other patients suffered permanent faecal incontinence postoperatively. The postoperative CCFI score was 0.5 ± 0.9. We consider m-OPIS + SSG as one of the efficacious options of procedure for chronic anal fissure and anal stenosis, owing to its high success rate, low recurrence rate and no postoperative complication of serious faecal incontinence. [ABSTRACT FROM AUTHOR]

To date, only 23 cases of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with duplex kidney have been reported. We present the first reported case of MRKH syndrome with solitary duplex kidney and anal stenosis. A 17-year-old Chinese girl presented with primary amenorrhea and fully developed secondary sex characteristics. Ultrasonography of the abdomen and pelvis revealed the absence of the right kidney, a left duplex kidney, and a primordial uterus. Surgery for anal stenosis was performed when she was 1 year of age. The patient had a normal 46, XX karyotype. [ABSTRACT FROM AUTHOR]

In patients who have undergone a colonic resection with creation of an end colostomy, drainage of mucus secreted by the mucosa of the rectal stump may not be possible if there is an outlet obstruction. With an outlet obstruction, formation of a rectal mucocele occurs. A rectal mucocele is a rare condition which has only been reported sporadically in case reports. We present here the utility of an intersphincteric proctectomy for treatment of a rectal mucocele in a 47 year old male Crohn’s patient resulting in negligible post-operative or long-term morbidities. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. • We report 30 years old patient presented with anal stenosis post hemorrhoidectomy. • A House advancement flap was used to cover the lost tissue. • The operation and the postoperative periods were uneventful. • House advancement flap anoplasty is a promising alternative for treating severe anal stenosis in resource limited centre. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: H-type rectovestibular or rectovaginal fistulas are rare entities in the spectrum of anorectal malformations seen in North America. Management options described in the literature have included perineal repair, anterior perineal anorectoplasty, vestibuloanal pull-through, and limited or formal posterior sagittal anorectoplasty, with a reported recurrence rate of 5% to 30%. We describe our approach and outcome in the management of these patients. Methods: In a series of 1170 females with anorectal malformation, we cared for 8 patients who had an H-type rectovestibular or rectovaginal fistula and reviewed their clinical presentation, diagnosis, operative technique, and postoperative course. Results: The patients'' presenting symptoms included passage of stool per vagina (6), constipation (3), labial abscess (1), and recurrent urinary tract infection (1). There was associated anorectal stenosis in 3 patients. The remaining 5 patients had normal anal openings. Endoscopy was not helpful in locating the fistulas, but the fistulas were all demonstrated on direct inspection under anesthesia. The fistula was located in the vestibule (4), vagina (3), or labia (1). One patient had an associated presacral mass. Two patients had been operated on twice previously using a perineal repair and a protective colostomy and presented with third recurrences. In 5 cases, a posterior sagittal approach was used, placing sutures circumferentially around the fistulous opening on the rectal side, ligating the fistula, and pulling down a normal segment of rectum to be placed in front of the repaired vaginal wall. In our last 3 cases, we performed a transanal mobilization of the anterior rectal wall, leaving the perineal body intact. After our repairs, the patients have been followed up for 3 months to 15 years with a median of 15 months, and we have seen no recurrences. Conclusions: In addition to vaginal passage of stool, an H-type fistula should be suspected when there is a labial abscess in an infant, and an associated anal stenosis or presacral mass must be checked for. Direct inspection is the key, with a careful look in the vestibule, because endoscopy may miss the fistula. The essential technical point for repair is to get healthy anterior rectal wall to cover the area of fistula on the posterior vagina. A transanal approach, leaving the perineal body intact, is an excellent option for this repair. [Copyright &y& Elsevier]

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 16 months to 5 years 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 30 min. 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. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Abstract: Perianal lesions are exceedingly common in Crohn''s disease and many patients have more than one type of lesion. Skin tags, fissures and haemorrhoids may persist over time and are usually managed expectantly or with topical therapy. Perianal and rectovaginal fistulas and associated abscesses often require both local and systemic therapy, and recurrence is common. In general, the clinical course of Crohn''s disease is more aggressive in patients with perianal involvement. Established risk factors for perianal disease include colonic disease and young age at disease onset. Classification schema now recognize perianal fistulas as distinct from other forms of penetrating Crohn''s disease. Genetic susceptibility factors for perianal disease may exist, but they remain incompletely delineated at present. There is hope that immunosuppressive and biotechnology medications will influence the natural history of perianal disease by preventing invasive surgeries, disease complications and recurrence, but this needs to be confirmed. Cancer, a rare complication of perianal disease, must be suspected when lesions persist despite therapy. [Copyright &y& Elsevier]

Perianal Crohn’s disease in children is a potentially debilitating condition that can precede or follow the intestinal disease component. The perianal abnormalities are varied and can include lesions of the perianal skin or anal canal, abscesses or fistulas, and malignancies. The appropriate management of these problems is predicated on a thorough evaluation of the perineum and anus as well as the remainder of the alimentary tract. Therapy usually includes a combination of antibiotics, immunomodulators, and biologic agents as well as conservative operative procedures. The surgical options are intended to safely ameliorate disease-related symptoms without compromising function or continence. [Copyright &y& Elsevier]

Abstract: We present a rare case of female newborn that presented with atypical genitalia, vaginal atresia and a short segment rectal stenosis which was successfully managed in a minimally invasive fashion using urological endoscopic and balloon dilatation technology. We believe that this technique is safe and feasible for short rectal stenotic segments and might prevent the need for major reconstruction surgery. [Copyright &y& Elsevier]