VM50 - Modified Bilateral House Flaps for Severe Anal Stricture Following Hemorrhoidectomy

Purpose/Background: Anal Stricture is one of the devastating complications of hemorrhoidectomy, it resulted from excessive excision of underlying anal mucosa usually in cases of 4th degree internal hemorrhoides or large circumferential thrombosed external hemorrhoides.
Incidence of anal strictures following hemorrhoidectomy is around 3-5%.
Anal strictures has significant impact on the quality of life and symptoms includes painful defecation, decrease caliber of stool, severe constipation and bleeding.
Treatment varies according to the severity of the stricture from conservative management in mild to moderate cases and surgical correction in severe cases in which the fibrosis is circumferential and and extending down beyond the dentate line.
We are presenting a simple modified technique of bilateral house flaps for the treatment of circumferential long fibrosis in the anus causing several anal stricture.

Methods/Interventions: This is a 53 yrs old male who undwent hemorrhoidectomy 18 months ago, subsequently pt started to experience gradual difficulty passing bowel moveemnt with pain and narrow caliber stool.
This condition affected his quality of life significantly
After preparation of the pt he was placed in prone jackknife position ,gentle finger dilatation done and the procedure started with circumferential cicatrix excision till we reach a normal paiable mucosa in the anal canal and we excised all fibrous tissure taking care not to injure the underlying sphincter muscles.
A bilateral house flaps was created where the length of the flaps are twice the width.both flaps were mobilized and the edges of the flaps where sutured down circumferentially to the normal anal mucosa making sure to secure hemostasis.both flaps defects were closed in interrupted fashion under no tension.
Pt has uneventful recovery and was followed up in weekly basis for 6 months where he has a normal healing and no recurrence.

Results/Outcomes: Patient stayed in hospital for 2 days and discharged home with daily dressing change. And no complications. He was followed up in the clinic till complete healing , then at 2,4,6 months interval.
He has improved quality of life and no recurrence.

Conclusion/Discussion: Modified bilateral house flap is a simple surgical technique used to treat severe cases of anal strictures that has a circumferential cicatrix that also extending down beyond the dentate line with dewer complication rate.