New application of the gluteal-fold flap for the treatment of anorectal stricture

Total intersphincteric resection (total ISR) is a surgical option for patients with advanced cancer of the lower rectum. However, anorectal stricture can develop after total ISR, which stretches from the anus to the lower rectum. Conventional anoplasty for anal stricture is often ineffective for them because the areas of stricture are long and the most proximal points of the strictures are too far for advancement flaps or rotation flaps to reach. We have developed a new surgical treatment method using a gluteal-fold flap (GFF) for anal stricture after total ISR. From April 2004 through June 2007, hemilateral GFFs were transferred to treat anorectal strictures after total ISR in three patients at the National Cancer Center Hospital East, Chiba, Japan. Postoperative results and anal function were evaluated. In all three patients, GFFs were successfully transferred, and good dilation of the anorectal stenosis was achieved. Postoperative anal function was satisfactory. The GFF has a rich vascular supply and can be simply and reliably transferred. We believe that GFF transfer is an excellent option for treating anorectal strictures after total ISR.