Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Apr 28, 2009; 15(16): 1921-1928
Published online Apr 28, 2009. doi: 10.3748/wjg.15.1921
Surgical treatment of anal stenosis
Giuseppe Brisinda, Serafino Vanella, Federica Cadeddu, Gaia Marniga, Pasquale Mazzeo, Francesco Brandara, Giorgio Maria
Giuseppe Brisinda, Serafino Vanella, Gaia Marniga, Pasquale Mazzeo, Giorgio Maria, Department of Surgery, Catholic University Hospital “Agostino Gemelli”, Rome 00168, Italy
Federica Cadeddu, Department of Surgery, University Hospital “Tor Vergata”, Rome 00133, Italy
Francesco Brandara, Department of Surgery, Hospital “Maria Paternò Arezzo”, Ragusa 97100, Italy
Author contributions: All authors contributed in editing the manuscript; All authors approved the final version of the manuscript.
Correspondence to: Giuseppe Brisinda, MD, Department of Surgery, Catholic University Hospital “Agostino Gemelli”, Largo Agostino Gemelli 8, Rome 00168, Italy. gbrisin@tin.it
Telephone: +39-6-30155398
Fax: +39-6-30156520
Received: February 14, 2009
Revised: March 13, 2009
Accepted: March 20, 2009
Published online: April 28, 2009

Anal stenosis is a rare but serious complication of anorectal surgery, most commonly seen after hemorrhoidectomy. Anal stenosis represents a technical challenge in terms of surgical management. A Medline search of studies relevant to the management of anal stenosis was undertaken. The etiology, pathophysiology and classification of anal stenosis were reviewed. An overview of surgical and non-surgical therapeutic options was developed. Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy. Treatment, both medical and surgical, should be modulated based on stenosis severity. Mild stenosis can be managed conservatively with stool softeners or fiber supplements. Sphincterotomy may be quite adequate for a patient with a mild degree of narrowing. For more severe stenosis, a formal anoplasty should be performed to treat the loss of anal canal tissue. Anal stenosis may be anatomic or functional. Anal stricture is most often a preventable complication. Many techniques have been used for the treatment of anal stenosis with variable healing rates. It is extremely difficult to interpret the results of the various anaplastic procedures described in the literature as prospective trials have not been performed. However, almost any approach will at least improve patient symptoms.

Keywords: Anal canal surgery, Anal stenosis, Anoplasty, Hemorrhoidectomy, Complications, Lateral internal sphincterotomy, Surgical flap