The House Advancement Anoplasty for Treatment of Anal Disorders.

Abstract

This procedure is simple, easy to construct and robust. It can be performed for a variety of anal disorders with satisfactory results and few complications and should be in every Coloproctologist's armamentarium.

Vergleichsstudie zum House-Advancement-Flap, Rhomboid-Flap und der Y-V-Anoplastik bei der Behandlung von Analstenosen

“…In knapp 7 Jahren wurden 60 Patienten mit einer Analstenose behandelt und nachuntersucht. Das bedeutet, dass im Schnitt 8 bis 9 Patienten pro Jahr operiert wurden (zum Vergleich: in St. Marks Hospital [1] 13 und in Kiel 3 in 5 Jahren).…”

Surgical treatment of anal stenosis

“…The width of the base of the house is designed to match the transverse incisions and hence the width of the mucosal defect to be replaced. It is necessary to preserve the subcutaneous vascular pedicle [2,7,26,31,32] . The flap is then easily advanced into the anal canal and sutured.…”

“…A significant advantage of these flaps over the Y-V anoplasty is that there is significantly greater mobility of the flap, so it can be advanced well into the anal canal. The diamond flap, House flap, and island flap have all been reported to yield excellent results [3][4][5][6][7][8]10,15,19,20,[22][23][24][25][26][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44] . The type of flap to be used is based on the surgeon's familiarity and choice as well as the patient's anatomy and the availability of adequate perianal skin for use in the various flaps.…”

“…These include flap necrosis from loss of vascular supply, infection or local sepsis, suture dehiscence from excessive suture line tension, failure to correct the stenosis, donor site problems, sloughing of the flap, ischemic contracture of the edge of the flap, pruritus, urinary tract infection subsequent to Clostridium difficile enterocolitis only in a few cases, fecal incontinence, constipation without stenosis, urinary retention, restenosis and ectropion if the flap is advanced too far and sutured at the anal verge [4][5][6][7]10,15,19,20,22,23,25,26,31,32,34,[36][37][38][39]41,42,44] .…”

“…In anatomic anal stenosis, the normal pliable anoderm, to a varying extent, is replaced with restrictive cicatrized tissue. Stenosis produces a morphologic alteration of the anal canal and a consequent reduction of the region's functionality, leading to difficult or painful bowel movements [6][7][8] .…”