Comparative Study of the House Advancement Flap, Rhomboid Flap, and Y-V Anoplasty
Condition: Anal Stenosis
MeSH terms: Anorectal Malformations; Constriction, Pathologic
Study type: Interventional

Summary: 
      This prospective randomized study included 60 consecutive patients suffering from anal
      stenosis in the period from April 2002 to December 2008. They admitted to colorectal surgery
      unit, Mansoura university hospital, Egypt. According to the classification proposed by Milson
      and Mazier(5), all patients had moderate to severe anal stenosis. There were 43 males and 17
      female with a mean age 34 + 5.2 years ranging from 18 up to 63 years.
    

Detailed description: 
      Informed consent was obtained from all patients to be included in the study, after
      explanations the nature of the disease and possible treatment. This study was approved by
      local ethical committee.

      The patients were then randomized into three groups. The randomization was achieved through
      computer-generated schedule and its results were sealed into 60 envelopes. The responsible
      surgeon opened randomly an envelop and, accordingly to the protocol.

      Group 1: consists of 20 (14 males and 6 females) patients underwent house door flap.

      Group II: consists of 20 patients (16 males and 4 females) underwent romboid flap.

      Group III: consists of 20 patients underwent V-Y anoplasty (13 males and 7 females).

      In group I: a house flap of healthy tissue was incised to the depth of ischiorectal fat. The
      flap consisted of skin and subcutaneous tissue. The flap was sufficiently mobilized without
      undermining its fatty base containing perforating blood vessels. The flap should be loose and
      easily advanced into the anal canal. When the ''base'' of this house-shaped flap was advanced
      into the anal canal defect, it was fixed to the top of the excised area with 3/0 Vicryl
      sutures.

      In group II: a rhomboid flap was incised in ischiorectal fossa and was mobilized without
      undermining of its fatty base into the anal canal so that the tip of rhomboid flap is sutured
      to the top of strictured area using vicryl 3/0.

      In group III: V-Y anoplasty is performed by making a v shaped incision in the perianal skin
      posteriorly starting from the lower end of the wound resultant from excision of scared area.
      A V-shaped flap is then dissected with preservation fatty base .The V flap is then advanced
      into the anal canal so that its tip is sutured to the top of structured area using vicryel
      3/0.

      Patients were discharged 48 hours after the procedure. A high-fiber diet combined with bulk
      laxatives with oral antibiotic coverage was recommended after discharge. After each bowel
      movement, cleansing of the operative site with a sitz bath or shower was prescribed.

      Patients were discharged 48 hours after the procedure. A high-fiber diet combined with bulk
      laxatives with oral antibiotic coverage was recommended after discharge. After each bowel
      movement, cleansing of the operative site with a sitz bath or shower was prescribed.

      The parameters investigated were time of relief of painful defecation, the straining
      severity, sensation of incomplete evacuation and need for laxative or enema. postoperative
      anal caliber, healing rate, recurrence, quality of life (QOL) was assessed with
      Gastrointestinal quality of life index (GIQLI) which is a relatively new and validated tool
      for measuring the QOL in patients with gastrointestinal diseases. The GIQLI developed by
      Eypasch and coworkers (6). The questionnaire comprises 36 multidimensional items covering
      symptoms and physical, emotional, and social dysfunction related to gastrointestinal diseases
      or their treatments. Each item is scored from 0 to 4 points. The GIQLI score is calculated by
      simple addition of all item scores so that an overall score of 0 would constitute the worst,
      while a score of 144 (36 X 4) represents the best possible result. It is also possible to
      evaluate the disease-specific, social, psychologic, and physical items as separate subgroups.
      The patients were asked to complete the GIQLI questionnaire at admission to the hospital and
      one year after surgery under the supervision of the same independent authors.
    

Intervention name(s): house advancement flap group; Rhomboid flap GROUP; Y-V anoplasty GROUP
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): A house flap of healthy tissue was incised to the depth of ischiorectal fat. The flap consisted of skin and subcutaneous tissue. The flap was sufficiently mobilized without undermining its fatty base containing perforating blood vessels. The flap should be loose and easily advanced into the anal canal. When the ''base'' of this house-shaped flap was advanced into the anal canal defect, it was fixed to the top of the excised area with 3/0 Vicryl sutures.; A rhomboid flap was incised in ischeorectal fossa and was mobilized without undermining of its fatty base into the anal canal so that the tip of rhomboid flap is sutured to the top of stricured area using vicryl 3/0.; Y-V anoplastyis performed by making a v shaped incision in the perianal skin posteriorly starting from the lower end of the wound resultant from excision of scared area. A V-shaped flap is then dissected with preservation fatty base .The V flap is then advanced into the anal canal so that its tip is sutured to the top of structured area using vicryel 3/0.
Other intervention name(s): group 1; Group 11; group 111
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: anal stenosis; flaps; anoplasty