title: Surgical Treatment of Anal Stenosis with Diamond Flap Anoplasty Performed in a Calibrated Fashion.
abstract: BACKGROUND
  Regarding anoplasty for anal stenosis, it is not clear to what extent the final anal caliber should be targeted.
  
  
  OBJECTIVE
  The aim of this study was to investigate the results of diamond-flap anoplasty performed in a calibrated manner for the treatment of severe anal stenosis due to a previous hemorrhoidectomy.
  
  
  METHODS
  Prospectively prepared standard forms were evaluated retrospectively.
  
  
  METHODS
  Anoplasty with unilateral or bilateral diamond flaps was performed for moderate or severe anal stenosis, targeting a final anal caliber of 25 to 26 mm. The demographic characteristics, causes of anal stenosis, number of previous surgeries, anal stenosis staging (Milsom and Mazier), anal calibers (millimeter), the Cleveland Clinic Incontinence Score, and the modified obstructed defecation syndrome Longo score were recorded on pre-prepared standard forms, as well as postoperative complications and the time of return to work.
  
  
  RESULTS
  From January 2011 to July 2013, 18 patients (12 males, 67%) with a median age of 39 years (range, 27-70) were treated. All of the patients had a history of previous hemorrhoidectomy. The number of previous corrective interventions was 2.1 ± 1.8 (range, 0-4), and 2 patients had a history of failed anoplasty. Five patients (28%) had moderate anal stenosis and 13 (72%) had severe anal stenosis. Preoperative, intraoperative, and 12-month postoperative anal calibration values were 9 ± 3 mm (range, 5-15), 25 ± 0.75 mm (range, 24-26), and 25 ± 1 mm (range, 23-27) (p < 0.0001, for immediate postoperative and 12-month postoperative anal calibers compared with the intraoperative). Preoperative and 12-month postoperative Cleveland Clinic Incontinence Scores were 0.83 ± 1.15 (range, 0-4) and 0.39 ± 0.70 (range, 0-2) (p = 1.0). The clinical success rate was 88.9%. No severe postoperative complications were observed.
  
  
  CONCLUSIONS
  This study was limited because it was a single-armed, retrospective analysis of prospectively designed data.
  
  
  CONCLUSIONS
  Diamond-flap anoplasty performed in a standardized and calibrated manner is a highly successful method for the treatment of anal stenosis caused by previous hemorrhoidectomy.
authors: 1 Department of Surgery, Liv Hospital, Ankara, Turkey 2 Department of Surgery, Gazi University Medical School, Ankara, Turkey.
authors: Merter
authors: M
authors: Gülen
authors: Sezai
authors: S
authors: Leventoğlu
authors: Bahadir
authors: B
authors: Ege
authors: B Bülent
authors: BB
authors: Menteş
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D001004:Anus Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003251:Constriction, Pathologic; D003672:Defecation / Q000502:physiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D061865:Hemorrhoidectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome