Anal Repair and Diamond Flap in Patient with Moderate Anal Stenosis After Open Hemorrhoidectomy Surgery: A Case Report

Patient: Female, 57-year-old Final Diagnosis: Anal stenosis after an open hemorrhoidectomy surgery Symptoms: Difficulty and discomfort in defecation Clinical Procedure: — Specialty: Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Anal stenosis due to anoderm scarring is usually caused by surgical trauma and decreases the patient’s quality of life significantly. Even though mild anal stenosis can be treated non-surgically, surgical reconstruction is unavoidable for moderate to severe cases of anal stenosis, especially stenosis that causes severe anal pain and the inability to defecate. In this study, we report the diamond flap method in the treatment of anal stenosis. CASE REPORT: A 57-year-old female patient reported difficulty and discomfort in defecation caused by anal stenosis 2 years after a hemorrhoidectomy surgery. On physical examination, a forceful dilatation was needed using the index finger; the size of the anal canal was precisely 6 mm, as measured by a hegar dilator. Laboratory tests results were normal. The patient underwent an anal repair and diamond flap procedure in which the scar tissue at 6 and 9 o’clock was excised and a diamond graft was incised carefully, with attention given to the vascular supply. Finally, the graft was sutured to the anal canal. After 2 days, the patient was discharged without any adverse event. Ten days after surgery, the diamond flap was in good condition and without any complications. The patient was then scheduled for further follow-up at the Digestive Surgery Division. CONCLUSIONS: Anal stenosis due to overzealous hemorrhoidectomy is a complication that is preventable when the procedure is performed by an experienced surgeon. The diamond flap was the option used for anal stenosis treatment and had few complications.