Double flap technique to reconstruct the anal canal after concurrent surgery for fistulae, abscesses and haemorrhoids

Benign anorectal conditions, such as abscess, fistulas and haemorrhoids may occur in the same patients, requiring wide excision of the diseased tissues. This may result in a large de-epithelized area of the anal canal, and removal of perianal skin, eventually leading to a stricture. A rectal mucosal advancement sutured to the apex of a skin rotation flap has been successfully used in four patients to partially reconstruct the anal canal and prevent the formation of an anal stenosis. Complex anal fistulas may be associated with haemorrhoids requiring a wide local excision. A large wound with loss of skin and epithelium may result, which is likely to heal causing an anal stricture. After simple open haemorrhoidectomy, three muco-cutaneous bridges are usually left by the surgeon at the end of the operation to prevent a stenosis, but this may be impossible to perform following haemorrhoidectomy and fistulectomy, procedures requiring wider tissue excision. A technique to create a muco-cutaneous bridge despite an extensive surgical wound had been successfully adopted in four patients with long standing multiple anal fistulas, pelvirectal abscess and haemorrhoids.