The Surgical Treatment of the Anal Stricture Post Hemorrhoidectomy Milligan-Morgan. A Comparison of Two Operatory Techniques

Surgical treatment of anal stricture in open posthemorrhoidectomy brings various complications to the open hemorrhoidectomy in 5 %-10 % of the cases. In books it is widely known as the fibrotic benign stricture or as iatrogenic stricture. Clinically, it is manifested with pain during defecation, minimal rectoragy and abdominal discomfort accompanied with a feeling of not having adequately emptied the bowels. Locally, it is manifested in the form of a rigid ring where even the small finger can hardly be penetrated. These symptoms can severely affect the quality of life in patients. Depending on the grade of the anal canal stricture, we can say that the anal stricture is found on three grades light anal stricture, moderated anal stricture and expressed anal stricture. All our patients resulted in expressed anal stricture. In our research we have compared two operative techniques which were applied for the surgical treatment of the pathology. Partial posterior internal sphincterotomy technique with anoplastic in the open wound (SIPA) and the plastic with skin flap and closed internal lateral sphincterotomy, V-Y advancement flap (PLSL). Each technique aims at relaxing the anal canal with as less continence damage as possible and faster rehabilitation of the patient. The patients were divided into two groups Group A of 15 patients treated with the SIPA technique and Group B of 14 patients treated with the PLSL technique. The study was conducted during February 2006 March 2014. The results favored the PLSL technique.