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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Anal Stricture Reconstruction

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Back to work
2-4 weeks
Success rate
85-95%
Recurrence
5-15%

What it is

What is Anal Stricture Reconstruction?

Anal stricture reconstruction, also known as anoplasty, is a surgical procedure to correct a narrowing (stenosis) of the anal canal. Stenosis can result from scarring after anorectal surgery (most commonly hemorrhoidectomy), chronic inflammation from conditions like Crohn's disease, or radiation therapy. The procedure involves releasing or excising the scar tissue and then advancing healthy, pliable skin or mucosal tissue (a flap) into the anal canal to widen the opening and restore its normal caliber and function. Several types of flaps can be used, including rectal advancement flaps and various anocutaneous flaps (e.g., V-Y, diamond, or house flaps), depending on the location and severity of the stricture.

Am I a candidate?

Who is a Good Candidate for Anal Stricture Reconstruction?

Ideal candidates are patients with symptomatic moderate to severe anal stenosis who have failed conservative management such as dietary changes, stool softeners, and gentle anal dilation. Patients who experience significant pain, incomplete evacuation, or require excessive straining or digital maneuvers to have a bowel movement are good candidates. The procedure is also indicated for patients with chronic anal fissures that are associated with an underlying stenosis. The choice of reconstructive technique depends on the location and length of the stricture, as well as the health of the surrounding tissues.

Recovery

What is the Recovery Like?

Recovery after anoplasty typically takes several weeks. Patients will experience moderate anal pain and some drainage from the incisions for the first 1-2 weeks. Pain is managed with oral pain medications and frequent warm sitz baths. It is crucial to maintain soft, bulky stools with a high-fiber diet and plenty of fluids to avoid straining, which could compromise the flap repair. Patients are typically advised to avoid strenuous activity for 2 to 4 weeks. Complete healing of the flaps can take 6 to 8 weeks. Regular follow-up is necessary to monitor for any signs of restenosis, which may require gentle dilation.

Risks & considerations

What are the Risks?

While anoplasty is generally a safe and effective procedure, it has potential risks, which include:

  • Pain: Postoperative pain is expected but is typically well-managed with oral pain medication, sitz baths, and stool softeners.
  • Bleeding: Minor bleeding or spotting from the suture lines is common. Significant bleeding is rare.
  • Infection or Flap Dehiscence: A wound infection can occur, which may lead to partial or complete breakdown (dehiscence) of the flap repair.
  • Fecal Incontinence: There is a small risk of new or worsened incontinence to flatus or stool, particularly if a sphincterotomy is performed in conjunction with the anoplasty.
  • Restenosis: The stricture can recur if the scar tissue reforms, which may require repeat dilation or another surgical procedure.
  • Mucosal Ectropion: A rare complication where the rectal mucosa prolapses slightly out of the anus, leading to moisture and irritation. This is more common with rectal advancement flaps.

Sources

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