ArticleJournal of the anus, rectum and colon2026
Subcutaneous Pedicle Advancement Flap Anoplasty with Pivot Point Medialization for Anal Stenosis: A Single-center Retrospective Study.
Article in Journal of the anus, rectum and colon, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Severe anal stenosis, particularly Whitehead deformity, presents a significant reconstructive challenge. This study reports the clinical outcomes of a modified subcutaneous pedicle advancement flap anoplasty emphasizing pivot point medialization, developed in collaboration with plastic surgeons. Methods: We retrospectively analyzed data from 52 consecutive patients (aged 32-97 years; median, 67) treated between April 2021 and June 2025. The etiologies included postsurgical cicatricial stenosis (65.4%) and chronic anal fissure (34.6%). The technique involves establishing the pivot point-defined in this study as the biomechanical anchoring point at the deep subcutaneous fat layer-allowing tension-free advancement of the flap medially without rotation while preserving blood flow through the subcutaneous pedicle. Forty-nine patients completed the 6-month follow-up. Bougie examination at 6 months was performed without anesthesia during outpatient visits. Results: Surgical success, defined as bougie passage of ≥22 mm (#9), was achieved in 48 of 49 patients (98.0%), with a median operative time of 24 min (range, 14-35 min). No flap necrosis occurred (0%). Complications included wound dehiscence in nine patients (17.3%), which healed conservatively within a median of 4 weeks, and rectal prolapse in one patient (1.9%). One patient (2.0%) showed insufficient dilation at 6 months and required reoperation at 12 months. No fecal incontinence was observed. Patient satisfaction at 3 months was high (very satisfied 63.5%, satisfied 21.2%, unchanged 15.4%, dissatisfied 0%). Conclusion: This technique, utilizing pivot point medialization and straight advancement without rotation, may offer a safe and effective option for severe anal stenosis.
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