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DOI: 10.1055/s-0045-1808934
SURGICAL TREATMENT FOR ANAL STENOSIS AFTER HEMORRHOIDECTOMY
Case Presentation A 60-year-old patient who underwent hemorrhoidectomy 2 years ago presented with progressive difficulty in evacuating, experiencing pain and a sensation of anorectal obstruction during bowel movements. Over this period, the symptoms persisted despite continuous use of laxatives, with recurrent fecalomas and episodes of abdominal distension and pain, necessitating emergency visits. On physical examination, a scar was noted in the perineal area, with anal stenosis that could only be passed with a small finger, and fibrosis in the anterior midline. The patient was submitted to surgery for anoplasty with a diamond-shaped flap, under anesthesia via spinal block. The procedure was filmed to demonstrate the steps of the surgical technique. The surgery began with marking the diamond-shaped flap, measuring approximately 3 cm at its largest axis in the perineal body. The fibrotic area in the anterior anal canal was resected, followed by mobilization of the flap to cover the defect area without tension while preserving its vascularization. After suturing the flap, the increased diameter of the anal canal was confirmed. The patient was discharged the day after surgery. She had a good immediate and long-term recovery, with daily bowel movements without strain or anorectal discomfort.
Discussion Anal stenosis is a rare complication of anorectal surgeries, most commonly occurring after hemorrhoidectomies. Treatment ranges from conservative measures to surgical correction in more severe cases. In the reported case, anoplasty with a diamond-shaped flap was chosen, as demonstrated in the video. However, several other techniques have been described with different healing rates, and there is no consensus on the best technique due to the lack of comparative prospective studies.
Conclusion Surgical treatment for anal stenosis is effective in cases refractory to conservative treatment. The procedure was completed without complications and filmed to showcase the steps of the surgical technique discussed in the video.
No conflict of interest has been declared by the author(s).
Publication History
Article published online:
25 April 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
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