Abstract

Acquired anal stenosis is a disabling complication of benign anorectal surgery, most frequently excisional hemorrhoidectomy, and reconstructive anoplasty is the mainstay of surgical care when conservative measures fail. Multiple flap designs have been described, but comparative data are limited. A narrative review of adult patients with acquired predominantly post-hemorrhoidectomy anal stenosis treated with anoplasty was conducted. Included evidence comprises single-center case series, two comparative cohorts (diamond versus V-Y flap; Y-V with versus without partial lateral internal sphincterotomy), a large consecutive sliding-graft series, and a narrative review that included a prospective randomized comparison of house, rhomboid, and Y-V anoplasty. Outcomes extracted were technique, healing or clinical success, recurrence, complications, continence, and patient-reported outcomes. Short-term healing or clinical improvement was commonly reported in the 90% range. Overall healing reached 97.8% in a 45-patient diamond-versus-V-Y cohort and 91–93% in a 25-patient Y-V cohort. Sliding skin graft anoplasty achieved “good” one-year results in 87% of 77 consecutive patients. Recurrence ranged from rare symptomatic restenosis manageable with dilation or a contralateral flap to a 7.7% reoperation rate in one mixed-technique cohort. Complications were predominantly minor wound issues; continence risk was concentrated in arms that combined anoplasty with sphincterotomy. Multiple tension-free anoplasty strategies produce comparable short-term success in selected patients. Technique should be tailored to the stenosis level, extent, and tissue availability, and continence should be monitored when sphincterotomy is added.

Key words: Anal stenosis, anoplasty, post-hemorrhoidectomy complications, advancement flap, diamond flap, house flap, narrative review