[Surgical treatment of anorectal disorders in 32 HIV-seropositive patients]

To describe the presentation and surgical treatment of anorectal pathology in HIV seropositive patients.

Retrospective study.

Department of surgery, University Medical Centre, Amsterdam, the Netherlands.

Retrospective review of the records of 32 HIV seropositive patients surgically treated for anorectal pathology in 1985-1992.

The 32 patients, homosexual males, had a total of 46 diagnoses for which they underwent 49 surgical interventions. Sixteen patients had an anorectal ulcer (14 in the anal canal, 2 in the distal rectum); 7 were treated by local excision and 9 with additional advancement of the anal mucosa; there were 4 and 2 recurrences, respectively. Ten patients had a perianal abscess; 5 a fistula, 2 of whom initially presented with a metastatic abscess in liver and brain. Eight patients had perianal warts, which in 2 cases showed severe dysplasia and in one an infiltrating carcinoma. Five patients presented primarily with a malignancy (3 with squamous cell carcinoma of the anus, 1 with cloacogenic carcinoma, 1 with non-Hodgkin lymphoma distally in the rectum). Twelve patients died within 6 months after the first operation.

In choosing therapy for anorectal disorders, the limited survival of HIV seropositive patients, especially those with an advanced stage of AIDS should be considered. Surgical treatment can improve the quality of life in these patients.