Is anoplasty superior to scar revision surgery for posthemorrhoidectomy anal stenosis?Six years of experience

BACKGROUND Anal stenosis is a rare but frustrating condition that usually occurs as a complication of hemorrhoidectomy.The severity of anal stenosis can be classified into three categories:mild,moderate,and severe.There are two main surgical treatments for this condition:scar revision surgery and anoplasty;however,no studies have compared these two approaches,and it remains unclear which is preferrable for stenoses of different severities.AIM To compare the outcomes of scar revision surgery and double diamond-shaped flap anoplasty.METHODS Patients with mild,moderate,or severe anal stenosis following hemorrhoidectomy procedures who were treated with either scar revision surgery or double diamond-shaped flap anoplasty at our institution between January 2010 and December 2015 were investigated and compared.The severity of stenosis was determined via anal examination performed digitally or using a Hill-Ferguson retractor.The explored patient characteristics included age,sex,preoperative severity of anal stenosis,preoperative symptoms,and preoperative adjuvant therapy;moreover,their postoperative quality of life was measured using a 10-point scale.Patients underwent proctologic follow-up examinations one,two,and four weeks after surgery.RESULTS We analyzed 60 consecutive patients,including 36 men(60%)and 24 women(40%).The mean operative time for scar revision surgery was significantly shorter than that for double diamondshaped flap anoplasty(10.14±2.31[range:7-15]min vs 21.62±4.68[range:15-31]min;P<0.001).The average of length of hospital stay was also significantly shorter after scar revision surgery than after anoplasty(2.1±0.3 vs 2.9±0.4 d;P<0.001).Postoperative satisfaction was categorized into four groups:45 patients(75%)reported excellent satisfaction(scores of 8-10),13(21.7%)reported good satisfaction(scores of 6-7),two(3.3%)had no change in satisfaction(scores of 3-5),and none(0%)had scores indicating poor satisfaction(1-2).As such,most patients were satisfied with their quality of life after surgery other than the two who noticed no difference due owing to the fact that they experienced recurrences.CONCLUSION Scar revision surgery may be preferable for mild anal stenosis upon conservative treatment failure.Anoplasty is unavoidable for moderate or severe stenosis,where cicatrized tissue is extensive.

Numerical analysis of pile–slope stability and the soil arching around two adjacent piles

Seismic pile–slope stability analysis and the formation mechanism of soil arching have not been well studied. This study used a threedimensional(3D) finite difference to determine soil and pile parameter changes in the static and seismic stability of the pile–slope caused by the interaction between stabilizing piles. Pile–slope stability analysis was performed to determine the optimal design of piles along a slope and the corresponding failure mode involving the formation of soil arching around two adjacent piles. The Factor of Safety(FS) of the slope was evaluated using the shear strength reduction method for static and seismic analyses. The results of the analysis show that suitable pile spacing(S) and a suitable pile diameter(D) in the middle of a slope result in the maximum FS for the pile–slope system and the formation of soil arching around two adjacent piles. FS of the pile–slope increased negligibly in the seismic analysis of piles located at the slope crest and toe. An optimized pile diameter and installation location afforded the maximum FS for the slope that corresponded to a specified slope failure mode for different pile locations. A pile spacing S ≤ 2.5D for piles installed in the middle of the slope is suggested for increasing the static and seismic pile–slope stability.