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.

Insights on in-office scar revision and resurfacing procedures

Objective:Many facial plastic surgery procedures can be performed in an office-based setting,ranging from simple chemical peels to reconstructive surgeries to assist with scar revision.The aim of this review is to summarize the current state of facial plastics in-office surgical procedures,including scar revision,dermabrasion,lasers,and chemical peels.Methods:A literature review was conducted with the PubMed search engine with the following keywords:facial plastics,scar revision,dermabrasion,lasers,chemical peels,face,office,and outpatient.The literature was surveyed for relevance,with a focus on realistically which procedures were performed in a facial plastics surgery outpatient clinic.These were then used to compile a review of the current state of this field.Results and Conclusions:There are various scar revision procedures that can be performed in the office setting,including z-plasty,w-plasty,and geometric broken line closure techniques,as well as various nonmedical treatment options to improve the appearance of a scar.Dermabrasion can also be performed to assist with elevated scars.Various lasers are available to enhance cell turnover in the field of facial rejuvenation,scarring,and sun damage.Chemical peels are also available to assist with facial rejuvenation.With the appropriate counseling of the patient and medical staff,these can be safely performed in the office.