Combination of simple advancement flap and fistulectomy to treat complex anal fistula as a complication of hemorrhoidectomy: Case report

Abstract

Introduction After hemorrhoidectomy, anal stenosis occurs, which is an uncommon but severe consequence. The majority of severe cases require advancement flap anoplasty. Presentation of case A 50-year-old female patient with a history of hemorrhoidectomy 10 months prior to admission complained of difficulty defecating, pain, and incomplete evacuation sensation, as well as a hole on the right side of the anal canal through which feces unintentionally passed. On the physical examination, we found that the anal lumen was partially obstructed, which did not allow the insertion of a finger. There was an impression of a perineal fistula at 5 and 7 o'clock, which was connected to the anal canal 3 cm from the edge of the anus. The patient was diagnosed with severe anal stenosis with perianal fistula. The patient underwent fistulectomy and advancement flap with perianal skin. In the outpatient follow-up clinic in the first and second weeks, the patient showed no complications, and no recurrence of her complaints was found. Discussion Several corrective surgical techniques have been applied to restore a healthy lining to the constricted portion of the anal canal. We performed a combination of simple cutaneous advancement flap and fistulectomy to manage the patient with severe anal stenosis following hemorrhoidectomy with concurrent anal fistula. Conclusion A combination of fistulectomy and simple cutaneous advancement flap anoplasty is a simple, safe, and effective surgical option for the management of severe anal stenosis with concomitant anal fistula.

Postoperative scar deformities of the perianal region: current state of the problem. (literature review)

“…( Rakhmanine M. et al ,2002) When analyzing the literature, it should be noted that new methods or combinations of known methods are constantly being developed and introduced in recent years. (Asfar S., 2018;Acar T et al, 2020;Sofii I, Irianiwati, Gunadi, Handaya AY, Fauzi AR.,2021;Sloane JA, Zahid A, Young CJ. ,2017) So, we can note the lack of a clear unanimous position on surgical intervention.…”

Surgical laser therapy for cryptoglandular anal fistula: Protocol of a systematic review and meta-analysis

“…Although there are a number of surgical treatment options available, such as ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment, adipose-derived stem cells, endorectal advancement flap, anal fistula plug and fibrin glue [ 7 – 11 ], their use is severely limited due to the high recurrence rate and the influence of sphincter function. The long-term effect and success rate of these surgical approaches are not as satisfactory as the traditional surgical method fistulotomy for simple anal fistula [ 12 , 13 ].…”