ROLE OF SIMULTANEOUS V-Y ADVANCEMENT FLAP DURING HEMORRHOIDECTOMY MILLIGAN-MORGAN IN PREVENTING ANAL STENOSIS

Background: Haemorrhoidectomy is the most effective and definitive treatment for Grade III and Grade IV haemorrhoids. Stenosis can complicate a radical amputative haemorrhoidectomy in 5%-10% of cases. The principle of anoplasty consists of increasing the diameter of the anal outlet and removal of cutaneous scarring by proximal or distal advancement flaps, thus decrease the severity of symptoms and restore normal function to the anus. Objective: We evaluated the success rate of Y-V advancement flap anoplasty in prevention post-haemorrhoidectomy anal stenosis (the most important complication of the procedure). Methods: A randomized controlled study was carried out among 80 patients, between September 2015 and September 2016, were treated surgically for grade III and IV haemorrhoids at the Department of General Surgery at Zagazig University Hospitals. Patients were Results: All our patients completed the scheduled follow-up of 12 months. All patients in our study were given spinal anesthesia. All patients in our study were put in lithotomy position intraoperative. The operative time was (32.61±2.89) (30-45) in the conventional group vs (16.84±1.98) (15-18) in the control group with a significant difference. Anal stenosis was observed in one patient (2.5%) in the conventional group vs 9 patients (22.5%) in the control group with significant difference (P value=0.017). Conclusion: Despite the extensive destruction of anoderm occurring during excision of large haemorrhoids, the wound healing is fairly un-problematic ,when simultaneous V-Y advancement flap anoplasty, and the risk of developing anal stenosis is in fact very small.