Double flap technique to reconstruct the anal canal after concurrent surgery for fistulae, abscesses and haemorrhoids

Benign anorectal conditions, such as abscess, fistulas and haemorrhoids may occur in the same patients, requiring wide excision of the diseased tissues. This may result in a large de-epithelized area of the anal canal, and removal of perianal skin, eventually leading to a stricture. A rectal mucosal advancement sutured to the apex of a skin rotation flap has been successfully used in four patients to partially reconstruct the anal canal and prevent the formation of an anal stenosis. Complex anal fistulas may be associated with haemorrhoids requiring a wide local excision.