Post Hemorroidectomy Anal Stenosis Diamond Flap Vs V_Y Flap: A Prospective Randomized Study

Background: Anal stenosis is diagnosed when there is a narrowing of the anal canal and subsequent loss of normal elasticity that makes its wall rigid and unable to be dilated to permit normal pain-free defecation. The aim of this work was to evaluate the outcomes of diamond flap versus V-Y flap for treatment of severe post hemorroidectomy anal stenosis. Methods: This prospective randomized study was carried out on 52 patients aged from 15 to 70 years old, both sexes, diagnosed with severe anal stenosis after hemorrhoidectomy. Patients were randomly allocated into two equal groups: Group A (Diamond flap group) underwent diamond flap, and group B (V-Y flap group) underwent the V-Y flap. All patients were subjected to: History taking, clinical examination, routine preoperative laboratory investigations, anaesthetic assessment, and preoperative bowel preparation.Results: Both procedures were associated with a significant increase in anal caliber measurements (P < 0.001). However, the improvement was more noticeable in the diamond flap group (P < 0.05). It increased from 10.5 mm before the procedure to 20.19 and 21.5 mm after one and six months, respectively. The same three readings were 10.62, 18.35, and 18.73 mm, respectively, in the V-Y group. There were significant differences regarding time to complete wound healing, and wound dehiscence (P < 0.05).Conclusions: Both Diamond and V-Y flap approaches are safe and efficacious in the management of severe post hemorrhoidectomy stenosis. However, the former is associated with better outcomes manifested in increased anal caliber, decreased morbidity rate, and decreased postoperative recurrence.