Comparative Study of the House Advancement Flap, Rhomboid Flap, and Y-V Anoplasty
Comparative Study of the House Advancement Flap, Rhomboid Flap, and Y-V Anoplasty
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.
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.
Inclusion Criteria:

 -  ALL PATIENTS with anal stenosis

 Exclusion Criteria:

 -  Pregnant female

 -  Malignant stenosis

 -  Associated anal pathology

 -  Anal stenosis with a anal diameter more than 20 mm