title: Transanal anorectal stricturoplasty using the Heineke-Mikulicz principle: a novel technique.
abstract: OBJECTIVE
  Current surgical options for the treatment of rectal stricture are either technically difficult or result in a high rate of recurrence. We describe the results of a simple and potentially effective technique of transanal stricturoplasty using the Heineke-Mikulicz principle.
  
  
  METHODS
  The medical records and a prospectively maintained database of patients with rectal stricture were searched. Those who underwent transanal stricturoplasty for an anorectal stricture from 2007 to 2013 were studied retrospectively. Morbidity, length of hospital stay and the rates of success and recurrence were recorded.
  
  
  RESULTS
  Fifteen patients with a symptomatic rectal stricture who failed dilatation underwent transanal stricturoplasty. The types of stricture included strictures in Crohn's disease (n = 7) and anastomotic stricture after stapled ileoanal anastomosis for ulcerative colitis (n = 4), after stapled hemorrhoidopexy (n = 3) and after low anterior resection for rectal cancer (n =1). The median (range) distance of the stricture from the dentate line was 4 (0-6) cm. Recurrence of symptoms after anal dilatation occurred at a median of 3 (1-4) weeks. The median follow up after transanal stricturoplasty was 21 (6-88) months. Two patients had symptomatic recurrence at 12 months and both underwent a repeat transanal stricturoplasty, resulting in persistent patency of the strictured area at the time of the last follow up, 10 and 26 months, respectively, after repeat transanal stricturoplasty. The remaining 13 had a satisfactory result.
  
  
  CONCLUSIONS
  Despite the retrospective nature of this report and the small sample size and short follow up, the results strongly suggest that transanal Heineke-Mikulicz-type stricturoplasty is a promising treatment for this important condition. This operation is easy to perform and may result in success.
authors.affiliation: New York Presbyterian Hospital, Weill-Cornell Medical College, New York, New York, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Lee
authors.affiliation: New York Presbyterian Hospital, Weill-Cornell Medical College, New York, New York, USA.
authors.forename: R
authors.initials: R
authors.lastname: Niec
authors.affiliation: New York Presbyterian Hospital, Weill-Cornell Medical College, New York, New York, USA.
authors.forename: N
authors.initials: N
authors.lastname: Melnitchouk
authors.affiliation: New York Presbyterian Hospital, Weill-Cornell Medical College, New York, New York, USA.
authors.forename: T
authors.initials: T
authors.lastname: Samdani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001004:Anus Diseases / Q000209:etiology / Q000601:surgery; D003093:Colitis, Ulcerative / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery; D003424:Crohn Disease / Q000150:complications; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures; D004106:Dilatation / Q000379:methods*; D005260:Female; D006484:Hemorrhoids / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012002:Rectal Diseases / Q000209:etiology / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D000067368:Transanal Endoscopic Surgery / Q000379:methods*; D055815:Young Adult
keywords: Transanal; rectal stricture; stricturoplasty