Some of them include pain, wound discharge, hematoma formation, anal stenosis
and anal fistulas12,13.
Development of anal stenosis
due to thermal damage from LigaSure usage has been described in many recent studies.
None of our patients developed anal stenosis
. This is probably related to the avoidance of unnecessary ligation sutures around the entire rectal column, which may disturb rectal arterial flow.
Severe anal stenosis
was found on physical examination, and total colonoscopy was performed before surgery, which showed a complete anal stricture (Figure 2).
These included the release of a contracture band across the perineum, repair of a single case of anal stenosis
, and multiple small skin grafts to the lower limbs to ensure complete skin cover before reversal of the colostomy.
On the 7th postoperative day (1st follow-up visit for the patients already discharged from hospital) a careful digital-rectal examination (DRE) was done by the author himself in all the patients to assess the anal tone and anal stenosis
Treatment toxicity Toxicity N (%) Acute Radiation dermatitis 7 (27) Thrombocytopenia 1 (3) Neutropenia 1 (3) Mucositis 1 (3) Late Anal stenosis
1 (3) Pain 1 (3) Table 4.
and spastic anal sphincter are known risk factors predisposing to foreign body impaction in the anal canal.
Consider rubber band ligation A systematic review of 3 poor-quality trials comparing rubber band ligation with excisional hemorrhoidectomy in patients with grade III hemorrhoids found that excisional hemorrhoidectomy produced better long-term symptom control but more immediate postoperative complications of anal stenosis
For example, despite the 44% complete response rate of fistulas in patients with perianal disease, two patients with perianal fistulas required abscess drainage, and two others underwent repeated anal dilatation for anal stenosis
Appropriate reasons for referral include any suggestion of persistent anal stenosis
, a palpable presacral mass, abnormal position of the anal opening, and Hirschsprung's disease, which can cause chronic constipation with or without abdominal distention.
On long-term follow-up, 2 patients out of 60 got faecal urgency resolved late, none got anal incontinence, 3 patients got intermittent bleeding not requiring major intervention, 1 patient got anal stenosis
requiring surgical intervention later.
Complications such as flap necrosis, anal stenosis
, incontinence and sexual dysfunction may occur after surgical excision and reconstruction.
Various complications of perineal burn contracture like intestinal obstruction, anal stenosis
with megarectum, and gluteal pouching with total effacement of the gluteal folds and hooding of the rectum have also been reported [12-14].
No patient in group A developed anal stenosis
, while 3 (2.91%) patients in group B developed anal stenosis