A Tailored Rhomboid Muco-cutaneous Advancement Flap to treat Anal Stenosis.

BACKGROUND: Anal stenosis (AS) is a rare but disabling disorder that often represents a complication of anorectal surgery. The aim of our study was to assess the safety and functional outcome of a modified rhomboid flap (MRF) in the treatment of moderate and severe AS. METHODS: Between January 2002 and September 2017, fifty consecutive patients with moderate and severe AS who underwent a MRF were retrospectively included. Anal continence [Cleveland Clinic Incontinence Score (CCIS)] and symptoms [Obstructed Defecation Syndrome Score (ODS-S)] were assessed pre- and postoperatively at 12 months. Furthermore, anal calibre was measured both pre- and post-operatively at 1, 6 and 12 months. RESULTS: The mean follow-up period was 97 ± 48.3 (33-180) months. The main aetiology was a previous excisional haemorrhoidectomy (N = 23; 46%). The mean preoperative anal calibre was 9.96 ± 2.68 (5-15) mm and there was a statistically significative improvement in all three periods (p < 0.0001) of post-operative evaluation (1, 6 and 12 months) with a mean difference, obtained comparing preoperative and 12 months anal calibre, of 24.06 ± 1.46 (21-26) (p < 0.0001). Statistically significant improvement in both CCIS and ODS-S was observed in all patients at 12 months. The overall success rate was 96% (48/50 pts). CONCLUSION: The use of a MRF is a safe and suitable option for the treatment of moderate and severe AS. The possibility of tailoring the flap, based on the degree as well as the level of AS, is the key.