Stenosis can complicate a radical amputative hemorrhoidectomy in 5%-10% of cases, particularly those in which large areas of anoderm and hemorrhoidal rectal mucosa from the lining of the anal canal is denuded, but can also occur after other anorectal surgical procedures. Stenosis produces a morphologic alteration of the anal canal and a consequent reduction of the region’s functionality, leading to difficult or painful bowel movements.Īnal stenosis is a serious complication of anorectal surgery. In anatomic anal stenosis, the normal pliable anoderm, to a varying extent, is replaced with restrictive cicatrized tissue. This narrowing may result from a true anatomic stricture or a muscular and functional stenosis. However, almost any approach will at least improve patient symptoms.Īnal stenosis is an uncommon disabling condition. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. Many techniques have been used for the treatment of anal stenosis with variable healing rates. Anal stricture is most often a preventable complication. Anal stenosis may be anatomic or functional. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Treatment, both medical and surgical, should be modulated based on stenosis severity. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. An overview of surgical and non-surgical therapeutic options was developed. The etiology, pathophysiology and classification of anal stenosis were reviewed. A Medline search of studies relevant to the management of anal stenosis was undertaken. Anal stenosis represents a technical challenge in terms of surgical management. Our findings indicate an acceptable complication rate among a group of surgeons beginning to integrate this modality into clinical practice.Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. This data suggests that stapled hemorrhoidectomy is a safe and effective approach to hemorrhoidal disease. No additional complications were discovered at follow-up. Postoperative follow-up was available for over 90 per cent of the patients at a median of 4 weeks postoperatively. One patient experienced urinary retention that resolved with conservative management. The second patient was subsequently found to have a bleeding diverticulum. The first patient was admitted overnight and required no blood transfusion or further intervention. One patient experienced bleeding the first evening, and the second patient had bleeding 1 week postoperatively. Two patients reported postoperative bleeding. Postoperative pain, defined as requiring pain control with intravenous medication, hospital admission, or an emergency department visit, occurred in two patients. There was one death unrelated to the hemorrhoid surgery. Sixty-two patients underwent this operation, and complications were reported in six patients (10%). Postoperative factors included complications and date of last follow-up. Operative factors examined included operating time, use of perioperative antibiotics, and oversewing of the suture line. Preoperative factors assessed included demographics, comorbidities, prior anorectal surgery, hemorrhoid grade, and the indications for surgery. Medical records from 62 patients treated by circumferential mucosectomy/stapled hemorrhoidectomy were obtained from 6 surgeons. Our purpose was to assess the safety and early post-op results of this new surgical technique as it was introduced into clinical practice. Treatment of hemorrhoids may safely be accomplished by using a circular stapler instead of the conventional open procedure for large symptomatic hemorrhoids.
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