대한대장항문학회

Anal stricture is a mechanical narrowing of the anal canal due to contracture of the<br>epithelial lining which has been supplanted by fibrous connective tissue. We reviewed 82<br>patients with anal strictures who were admitted at Song-Do Colorectal Hospital from<br>Jan. 1994 to Dec. 1996. The etiology of the strictures were injection therapy with<br>necrotizing agent in 62 patients(78%), secondary to hemorrhoid and fistular operations in<br>13 patients(17%), and other causes in 7 patients(8.5%). The degree of anal stricture was<br>mild in 40 patients, moderate in 33 patients, and severe in 9 patients. The operation<br>methods used to treat the anal strictures were infernal sphincterotomy in 27 patients,<br>local advancement flap in 42 patients, and rotational flap in 13 patients; the selection of<br>the operation method was based on the cause, severity and level of the stricture. During<br>the local advancement or rotational flap operation, a concurrent internal sphincterotomy<br>was also employed in selected patients who had a fibrotic muscular component<br>contributing to the stricture. We preferred to use a sliding skin graft in the<br>advancement flap operation and a C-flap in rotational flap operation. According to a<br>follow-up study with an average follow-up of 20 months, 24 of the 27 patients with<br>mild stricture, 19 of the 24 patients with moderate stricture, and 7 of the 8 patients with<br>severe stricture had good results, and remained 3 patients with mild stricture, 5 patient<br>with moderate stricture, and 1 patient with severe stricture had fair results. Mild anal<br>strictures were effectively treated by sphincterotomy or one or two sliding skin grafts,<br>moderate to severe anal strictures with diaphragmatic type were treated by<br>anorectoplasty, and moderate to severe low anal stoictures with annular type were<br>effectively treated by two or three sliding skin grafts. Based on these results, sliding<br>skin grafts should be effective in most cases of moderate to severe anal canal stricture,<br>although occasionally a rotational flap may be indicated in cases of severe lack of the<br>anoderm.<br>