title: Use of a Heineke-Mikulicz like stricturoplasty for intractable skin level anal strictures following anoplasty in children with anorectal malformations.
abstract: BACKGROUND
  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 16months to 5years 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 30min. 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.
authors: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: takeemlawal@gmail.com.
authors: Taiwo A
authors: TA
authors: Lawal
authors: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA.
authors: Carlos A
authors: CA
authors: Reck
authors: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA.
authors: Richard J
authors: RJ
authors: Wood
authors: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA.
authors: Victoria A
authors: VA
authors: Lane
authors: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA.
authors: Alessandra
authors: A
authors: Gasior
authors: Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA.
authors: Marc A
authors: MA
authors: Levitt
mesh_terms: D001003:Anal Canal / Q000002:abnormalities / Q000601:surgery*; D000071056:Anorectal Malformations / Q000601:surgery*; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum / Q000002:abnormalities / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Anal stenosis; Anal stricture; Anorectal malformation; Imperforate anus; Stricturoplasty