Copyright ©2009 The WJG Press and Baishideng.
World J Gastroenterol. Apr 28, 2009; 15(16): 1921-1928
Published online Apr 28, 2009. doi: 10.3748/wjg.15.1921
Table 1 Anoplasty for anal stenosis
Partial lateral internal sphincterotomyFunctional stenosis; mild and low stricture in the anal canalThis technique is simple and safe. Use is limited to functional stenosis
Mucosal advancement flapMiddle or high localized strictureEctropion formation if the flap is sutured at the anal verge
Y-V advancement flapLow and localized stricture below the dentate lineProximal part of the flap is very narrow and will not allow for a significant widening of the stricture above the dentate line. Also, the tip of the V within the anal canal is subject to ischemic necrosis from lack of mobilization, tension of the flap or loss of vascularization
V-Y advancement flapMild to severe stricture at the dentate line. Middle or high localized strictures, associated with mucosal ectropionThe tip of the V is subject to ischemic necrosis
Diamond flapModerate to severe long stricture, localized or circumferential stricture above the dentate line, associated with mucosal ectropionA diamond-shaped flap is designed so that it will cover the intra-anal portion of the defect. The flap is mobilized with minimal undermining to preserve the integrity of the subcutaneous vascular pedicle
House flapModerate to severe long stricture, localized or circumferential or diffuse, and stricture above the dentate line, associated with mucosal ectropionIt allows primary closure of the donor site and increases anal canal diameter along its length. Because of the wide base, it avoids the pitfall of having a narrow apex present inside the anal canal that may become ischemic
U flapModerate to severe stricture, localized or circumferential, associated with mucosal ectropionThis technique is particularly useful when there is need to excise a significant area of ectropion. The donor site is left open
C flapModerate to severe stricture, localized or circumferential, associated with mucosal ectropionThe donor site is left open
Rotational S flapHigh severe stricture, circumferential or diffuse, associated with mucosal ectropionIt provides for adequate blood supply, avoids tension, and can be performed bilaterally if necessary for coverage of large areas of skin. Complex technique: high morbidity and longer hospital stay
Table 2 Experiences in literature
AuthorsNo. of casesProcedureResults
Healing rate (%)
Sarner et al[45]21Sarner’s flap---100
Nickell et al[46]4Advancement flap anoplasty4--100
Oh et al[41]12C anoplasty11-190
Khubchandani[40]53Advancement flap anoplastyNrNrNr94
Milsom et al[6]24V-Y anosplasty and Sarner’s anoplasty---90
1Gingold et al[28]14Y-V anoplasty95-64
Caplin et al[11]23Diamond flap anoplasty23--100
Ramanujam et al[30]21Y-V anoplasty182195
Pearl et al[29]25Island flap anoplasty167292
2Angelchik et al[23]19Y-V anoplasty (12 cases)840100
Diamond flap anoplasty (7 cases)7--100
Pidala et al[42]28Island flap anoplasty25391
Eu et al[38]9Lateral internal sphincterotomy (5 patients) and anoplasty (4 cases)9--100
Gonzalez et al[39]17S anoplasty (6 cases) and advancement flap anoplasty (11 cases)16-192
Sentovich et al[32]29House advancement flap26-390
Saldana et al[34]1Internal pudendal flap anoplasty1--100
Aitola et al[25]10Y-V anoplasty with internal sphincterotomy63160
de Medeiros[47]30Sarner’s flap or Musiani’s flap---100
Maria et al[5]42Y-V anoplasty (29 cases)26-390
Diamond flap anoplasty (13 cases)13--100
Stratmann et al[44]3----100
Ettorre et al[26]1House advancement flap1--100
Saylan[20]3Y-V anoplasty---100
3Rakhmanine et al[24]95Lateral mucosal advancement anoplasty74-890
Carditello et al[36]149Internal sphincterotomy and mucosal flap anoplastyNrNrNr97
Habr-Gama et al[15]77Sarner’s flap (58 patients) and Musiani’s flap (19 patients)---87
Filingeri et al[27]7Y-V anoplasty---100
Casadesus et al[1]19Y-V anoplasty (7 patients) and lateral mucosal advancement flap anoplasty (12 patients)---100
Alver et al[31]8House advancement flap (14 flaps: 1 flap for 2 patients, and 2 flaps for 6 patients)6--100