DOUBLE FLAP TECHNIQUE TO RECONSTRUCT THE ANAL-CANAL AFTER CONCURRENT SURGERY FOR FISTULAS, ABSCESSES AND HEMORRHOIDS

Benign anorectal conditions, such as abscess, fistulas and haemorrhoid s may occur in the same patients, requiring wide excision of the disea sed tissues. This may result in a large de-epithelized area of the ana l canal, and removal of perianal skin, eventually leading to a strictu re. A rectal mucosal advancement sutured to the apex of a skin rotatio n flap has been successfully used in four patients to partially recons truct the anal canal and prevent the formation of an anal stenosis. Co mplex anal fistulas may be associated with haemorrhoids requiring a wi de local excision. A large wound with loss of skin and epithelium may result, which is likely to heal causing an anal stricture. After simpl e open haemorrhoidectomy, three muco-cutaneous bridges are usually lef t by the surgeon at the end of the operation to prevent a stenosis, bu t this may be impossible to perform following haemorrhoidectomy and fi stulectomy, procedures requiring wider tissue excision. A technique to create a muco-cutaneous bridge despite an extensive surgical wound ha s been successfully adopted in four patients with long standing multip le anal fistulas, pelvirectal abscess and haemorrhoids.