HOUSE FLAP ANOPLASTY TECHNIQUE FOR SURGICAL TREATMENT OF IDIOPATHIC ANAL STENOSIS

Introduction/Case Presentation A 71-year-old male patient with a history of hypertension and diabetes, with no history of anal trauma or previous surgeries, presented with difficulties during bowel movements for the past 10 years. The patient reported significant straining and narrowing of the stool without any bleeding. Additionally, the patient had a suspicious nodule in the prostate but was unable to undergo a biopsy due to anal canal stenosis. The patient was referred for evaluation by a coloproctologist. On initial proctological examination, there was evidence of anal canal stenosis, identified as a fibrotic ring with resistance to digital examination. Colonoscopy was performed with adequate bowel preparation, revealing only hypertrophic papillae in the anal canal, with no further abnormalities extending to the terminal ileum. The patient was treated conservatively with hygiene measures, dietary modifications, and topical treatment with Diltiazem. However, the patient experienced headaches as a side effect of the ointment and reported no improvement in the evacuation symptoms after 3 months of the instituted measures. A surgical approach was then chosen, and the patient underwent analplasty using the modified skin advancement flap technique (House Flap).

Objective The goal of this video is to demonstrate the skin advancement flap technique, illustrating the step-by-step procedure as a surgical approach to anal stenosis. It includes positioning the patient, surgical technique, and postoperative results.

Conclusion After the surgery, the patient showed an open anal canal on proctological examination, with no resistance during digital examination. The postoperative course was uneventful, and the patient reported improvement in evacuation symptoms, including daily bowel movements without alterations, which allowed him to return to his normal lifestyle. Anal stenosis is a rare condition but can cause significant discomfort during defecation. It is commonly described as a complication following hemorrhoidectomy, chronic anal fissures, or inflammatory bowel disease. However, in this case, no specific cause for the pathology was identified. The House Flap technique demonstrated in this video should be part of the coloproctologist’s surgical repertoire, as it is a reproducible and effective approach for managing this condition.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025